In 2022, 817 U.S. women died either while pregnant or soon after giving birth, down from 1,205 the previous year.

“If you look at 2021, we had such a sharp increase as we were really still in the pandemic and still dealing with disruptions of care, the fear of coming into the healthcare space and the inability to access care during that time,” said Dr. Veronica Gillispie-Bell, an OB-GYN at Ochsner Medical Center in Kenner, Louisiana. She was not involved in the new report, which was published Thursday by the CDC’s National Center for Health Statistics.

The maternal mortality rate in 2022 was 22.3 deaths per 100,000 live births, compared with 32.9 per 100,000 in 2021, according to the new report.

“It’s looking like it’s returning to a pre-pandemic level,” said Donna Hoyert, the report’s author and an NCHS health scientist. The same appears to be true for preliminary 2023 data, she said.

Decreases were noted across all age groups and races, though Black women continue to be disproportionately affected. Their maternal mortality rate was 49.5 deaths per 100,000 live births in 2022. In 2021, it was 69.9 deaths per 100,000.

“We still have a long way to go to create really meaningful prevention interventions and strategies to decrease mortality,” said Dr. Warner Huh, an OB-GYN and head of obstetrics and gynecology at the University of Alabama at Birmingham, “particularly among Black women and women of color.” Huh was not involved with the NCHS report.

The accuracy of NCHS’s maternal mortality data, which comes from death certificates, has long been scrutinized. More than a decade ago, the research group noted that many deaths among pregnant women were not being counted because of a problem with medical coding.

In 2003, the NCHS tried to correct the issue by recommending that states add a standardized checkbox to the certificates to make it clear whether the death occurred in a pregnant or recently pregnant woman. It wasn’t unti

A study published last month suggested the checkbox rule grossly overestimated rates of maternal mortality because it wasn’t nuanced enough to determine whether the cause of death was truly related to pregnancy.

Gillispie-Bell, also the medical director of the Louisiana Perinatal Quality Collaborative at the state’s department of health, said she disagreed with those findings because they did not account for mental health conditions.

And according to CDC data, the most common cause of death during or just after pregnancy is related to mental health conditions, which include drug and alcohol use disorder.

Hoyert said her group continues to refine the quality of the data.

“If we didn’t use the checkbox, we would be right back where we were in the past, when we were getting roundly criticized for missing a substantial percent of maternal deaths,” she said.

While it appears that the numbers are “trending in the right direction,” Huh said, “they’re still too high.”

“No mother should come into pregnancy with a fear that she is going to die delivering her baby,” Gillispie-Bell said. “As long as mothers are dying, we still have work to do.”

This story first appeared on NBCNews.com. More from NBC News:

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The agency has been conducting tests on 297 pasteurized retail dairy products after findings last week showed that fragments of the virus had gotten into the commercial milk supply.

The tests showed that the products didn’t contain live virus that could make people sick, the FDA said Wednesday.

The new results, though still preliminary, “affirm the safety of the U.S. commercial milk supply,” Don Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition, said during the briefing. The samples come from 38 states.

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In addition, the FDA has tested powdered infant and toddler formulas and found no evidence of bird flu virus. It was unclear how many formula samples were tested.

Prater said the latest findings confirm that the pasteurization process inactivates the virus, making it unable to infect people. The FDA is also testing raw milk for live virus, though it strongly advises against drinking raw, unpasteurized milk.

Bird flu has now been detected in 36 dairy herds in nine states: Colorado, Idaho, Kansas, Michigan, New Mexico, North Carolina, South Dakota, Ohio and Texas.

Those cases appear to have all originated among herds in Texas, then spread as cattle were moved across state lines to other farms.

In affected herds, about 10% of the cows show symptoms, Dr. Rosemary Sifford, chief veterinary officer at the U.S. Department of Agriculture, said during the call. Most recover on their own within about two weeks, she said.

Sifford said that it appears the virus spreads between cows through affected raw milk, which contains high levels of the virus.

There is no evidence yet that this strain of the bird flu, called H5N1, spreads easily from person to person. But the concern is that the longer the virus spends in mammals, it could mutate into a form that does.

For now, Sifford said, that doesn’t seem to be happening.

“We are not seeing any changes in the virus that would indicate it is in a position to be more easily spread between people,” Sifford said.

The risk to the general public remains low, said Dr. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases.

One person, a dairy worker in Texas, has been diagnosed with the virus since the outbreak was detected in dairy cows. The person’s case was mild and the only symptom was conjunctivitis, or pink eye.

The Centers for Disease Control and Prevention said Wednesday that more than 100 people have been asked to monitor themselves for symptoms for 10 days after coming into contact with an infected animal.

Around 25 have been tested for the virus, Daskalakis said.

He said there is no indication of “unusual flu activity in people, and that includes avian influenza.”

But there have been reports that other cases may have gone undetected.

Multiple dairy workers in Texas were sick with fevers, body aches, upset stomach and eye infections at the same time the bird flu was working its way through cows in Amarillo, Dr. Barb Petersen, the veterinarian who discovered what was making the animals sick, previously told NBC News.

No hospitalizations or deaths have been reported.

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Johnson & Johnson on Wednesday said it plans to pay $6.5 billion over 25 years to settle nearly all of the thousands of lawsuits in the U.S. claiming its talc-based products caused ovarian cancer, pending approval of the claimants.

Those cases have for decades caused financial and public relations trouble for J&J, which contends that its now-discontinued talc baby powder and other talc products are safe for consumers. About 99% of the talc-related lawsuits filed against J&J and its subsidiaries stem from ovarian cancer. 

The company recorded a charge of about $2.7 billion in the first quarter to raise its reserve for talc claims to about $11 billion.

The deal, pending approval by claimants, would allow J&J to resolve the lawsuits through a third bankruptcy filing of a subsidiary company, LTL Management. Courts have rebuffed J&J’s two previous efforts to resolve the lawsuits through the bankruptcy of that subsidiary, which was created to absorb the company’s talc liabilities.

J&J will begin a three-month voting period for claimants, in hopes of reaching a 75% support threshold needed for a bankruptcy settlement that would end the litigation entirely and prevent future lawsuits. Claimants did not have the opportunity to vote in LTL Management’s previous bankruptcy cases, J&J executives said on a call with investors on Wednesday.

J&J has the “significant support of the overwhelming majority of the claimants” based on conversations with their lawyers or representation, the executives added.

“We firmly believe this plan is in the best interest of claimants and should receive a favorable and immediate confirmation from the bankruptcy court,” said Erik Haas, J&J’s worldwide vice president of litigation, during the call.

He contended the settlement is a far better recovery for claimants than would be likely in a trial.

“As that track record shows, most of bearing claimants have not recovered, nor are they expected to ever recover anything at trial,” Haas said. “At the rate at which use cases have been tried, it would take decades to try the remaining cases meaning most claimants will never see their day in court.”

Still, litigation has resulted in some large verdicts for claimants. That includes a roughly $2 billion award in favor of 22 women who blamed their ovarian cancer on asbestos in J&J’s talc products.

Shares of J&J closed more than 4% higher Wednesday.

J&J said the remaining pending lawsuits relate to a rare cancer called mesothelioma and will be addressed outside of the new settlement plan. The pharmaceutical giant said it has already resolved 95% of mesothelioma lawsuits filed to date.

J&J noted on Wednesday that it has reached “final and comprehensive” settlements to resolve an investigation by a coalition of more than 40 states into claims the company misled patients about the safety of its talc baby powder and other talc-based products.

The company has also reached an agreement in principle to resolve claims brought by suppliers of its talc, which include Imerys Talc America, Cyprus Mines Corporation and their related parties.

On TikTok, there are hundreds of videos from people claiming the practice can do even more: whiten teeth, reverse tooth decay, fight gum disease, and treat a number of oral health conditions.

The practice has evolved from taking a spoonful of coconut or sesame oil to using pricey single-use oil pulling packets that come in a variety of fancy flavors.

How does oil pulling work and is there any validity to these claims about its benefits?

How does oil pulling work?

“Oil polling has been around for thousands of years as a way to better oral hygiene,” Dr. Matt Messina, clinic director of Ohio State Upper Arlington Dentistry, tells TODAY.com.

The traditional remedy is rooted in the Ayurvedic medicine system and has been practiced widely in India and Southern Asia.

“It’s a tradition that’s now being adopted because it’s trendy … I think it’s become popular over the last couple of years with the idea of, how do I find something ‘natural’ to make my mouth healthier,” Dr. Suhail Mohiuddin, Chicago-based dentist and founder of Dentologie, tells TODAY.com.

Oil pulling starts with taking a tablespoon of an edible oil and placing it in the mouth. Coconut oil is commonly used for oil pulling, Dr. Mark Wolff, dean of Penn Dental Medicine, tells TODAY.com. Sesame oil, olive oil, and sunflower oil may also be used — as long as the oil is edible, the experts note.

Next, the oil is vigorously swished around in the mouth similar to mouthwash, the experts note. “The idea is you sort of chew the oil around and ‘pull,’ by creating your own suction to tug it between the teeth and the gums,” says Messina.

After swishing the oil around for some time — oil pulling techniques vary but the practice can last anywhere from two to 20 minutes — you spit the oil out, says Messina.

Oil pulling is thought to help clean the teeth and reduce bacteria in the mouth, which can lead to the buildup of plaque and tooth decay. “Gingivitis or gum disease is basically inflammation of your gums caused by plaque, which is a biofilm,” Mohiuddin adds.

Oil pulling benefits

Although people have been practicing oil pulling for centuries to boost oral health, the research is limited and mixed, at best, the experts note.

“It’s (going) around on social media as an alleged method for reducing tooth decay, bad breath, gum disease (gingivitis), and a whole litany of of untested health items,” says Wolff. Some influencers tout oil pulling for its systematic benefits, including improving skin health and “detoxing” the body.

Overall, there aren’t enough robust, large-scale clinical studies clinical trials demonstrating these benefits, says Wolff.

“There are no reliable scientific studies to show that oil pulling reduces cavities, whitens teeth or improves oral health and well-being,” according to the American Dental Association.

One way cavities form is when the pH of the mouth is too acidic (below 5.5), which can cause the demineralization or erosion of enamel, says Mohiuddin. “There is no data that suggests that oil pulling can change the pH of the mouth,” he adds.

A 2022 meta-analysis investigating the effects of oil pulling on oral health found that oil pulling may have potential benefit in reducing salivary bacteria colony counts, but had no significant effects on reducing plaque or gingivitis.

As for removing toxins from the body, there’s no evidence oil pulling can do this, and the body detoxes itself on its own just fine with help from the liver, kidneys, lungs, and digestive system, TODAY.com previously reported.

“The real hard science on it is not very strong,” says Woolf.

While many of the supposed benefits of oil pulling are “somewhat questionable,” says Messina, the practice may still have a place in dental hygiene.

“The oil pulling method can have some effectiveness in removing loose debris from around the gum tissues and the teeth,” says Messina. “Anything that we do to remove food debris, plaque, or bacteria from the teeth is certainly beneficial,” Messina adds.

However, other methods like toothbrushes and flossing will do a much better job, the experts note. Our oral hygiene tools and capabilities have changed drastically in just the last 100 years, Messina points out. Compared to newer methods, oil pulling has a minimal effect on reducing debris and bacteria in the mouth.

Once a biofilm or plaque forms, oil pulling will “have no impact, or no greater impact than rinsing with water,” says Mohiuddin. “The only way to properly remove plaque is with a mechanical interruption, such as brushing or flossing,” Mohiuddin adds.

“Now we even have water flossers and irrigators to power-pull or power-rinse to get between the teeth and below the gum line — it’s simply a case of we’ve gotten better,” Messina notes.

“Oil pulling is a historic method that has been supplanted by some better ways to clean our teeth,” says Messina. That’s why it’s important to use oil pulling as a supplementary dental hygiene practice in addition to brushing and flossing, not as a replacement for these methods.

Oil pulling side effects

“Oil pulling is not in any way dangerous. There’s nothing wrong with it, there’s nothing bad about it — there’s no scientific evidence to indicate benefit or harm,” says Messina.

Compared to other trendy oral hygiene hacks on social media, such as brushing the teeth with charcoal (which is abrasive and harmful to enamel, says Messina), oil pulling is “pretty benign,” he adds.

Edible oils are used for oil pulling, which are safe to put in the mouth and swallow, even though the oil is meant to be spit out at the end, the experts note. “We’re not talking about engine oil (or) any petroleum-based oils. That would not be safe,” says Wolff.

Swallowing too much of these edible oils may cause stomach upset or diarrhea, says Wolff. Otherwise, oil pulling is generally pretty safe.

“The only time I would argue that oil pulling could be considered dangerous is if someone it has, say an infection or periodontal disease, and you’re using oil pulling instead of a known beneficial treatment,” says Messina.

Should you brush your teeth after oil pulling?

It’s typically recommended to brush your teeth after oil pulling, the experts note.

“Depending on what oil you’re using, if your mouth tastes like a salad, you might brush a little longer with some more toothpaste,” says Messina.

How often to oil pull

Most of the recommendations around oil pulling suggest doing the practice one to two times per day, the experts note. “If oil pulling is being done as as an additional treatment, there’s nothing wrong with that,” says Messina.

Avoid swallowing the oil, and spit it into the trash can instead of the sink when you’re done, as the oil can clog pipes, TODAY.com previously reported.

Do dentists recommend oil pulling? 

Due to the lack of scientific evidence, the American Dental Association does not recommend oil pulling as a dental hygiene practice.

“I would personally not recommend it as I can’t find the science to support it,” says Wolff.

Adds Messina: “Dentists aren’t going to recommend it because there’s no scientific basis to say that it’s beneficial, but we’re certainly not going to discourage it unless people are going to do this instead of something that is beneficial.”

Mohiuddin agrees that while most dentists won’t recommend oil pulling, “as long as you’re also brushing with a fluoride toothpaste, flossing or using a water-flosser, I don’t think they’re going to care,”

What the ADA and dentists do recommend is brushing twice a day with a fluoride-containing toothpaste for at least two minutes and flossing once a day. It’s also important to avoid tobacco, visit your dentist for yearly examinations and get routine cleanings.

As with any claim about any remedy on social media, try to look for trusted sources and talk to your dentist if you have any questions or want to change your dental hygiene routine.

“Everybody’s oral health needs are different. … Your dentist can give recommendations for your individual situation,” says Messina.

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Bird flu has been found in nearly three-dozen dairy herds across nine states. The new testing is the latest effort by the USDA to track and understand how the virus is spreading among livestock.

Two studies will test if particles of the bird flu virus, called Type A H5N1, is found in beef for sale in the states where dairy cows have tested positive or in the muscles of dairy cows sent to slaughter. A third will test how cooking meat at different temperatures affects the virus using a bird flu surrogate.

A week ago, the U.S. Food and Drug Administration confirmed it found non-infectious remnants of the bird flu virus in pasteurized milk. The particles are inactive and pose no threat to consumers, experts said.

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Scientists say there’s no evidence to suggest people can get bird flu by consuming food that’s been pasteurized or properly cooked.

The virus was first found in dairy cows this spring, and since then, H5N1 was detected in the lung tissue of a dairy cow culled and sent to slaughter.

So far, officials with the U.S. Centers for Disease Control and Prevention have not seen signs that the virus is changing to be more transmissible to people. Two farmworkers have been infected with bird flu since the outbreak began.

AP Health Writer JoNel Aleccia contributed to this report.

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Federal Trade Commission on Tuesday sent warning letters to 10 drugmakers, taking issue with patents on popular drugs for weight loss, diabetes, asthma and other respiratory conditions. The letters allege that certain patents filed by Novo Nordisk, GlaxoSmithKline, AstraZeneca and seven other companies are inaccurate or misleading.

Brand-name drugmakers use patents to protect their medicines and stave off cheaper, generic medicines. Most blockbuster drugs are protected by dozens of patents covering various ingredients, manufacturing processes and intellectual property. Generic drugmakers can only launch their own cheaper versions if the patents have expired or are successfully challenged in court.

“By filing bogus patent listings, pharma companies block competition and inflate the cost of prescription drugs, forcing Americans to pay sky-high prices for medicines they rely on,” said FTC Chair Lina Khan, in a statement.

Ozempic is part of a class of drugs that were originally developed to treat diabetes but which have recently been approved to treat obesity, generating a surge in prescribing. Medicare spending on the drugs has also spiked in recent years.

The drug’s manufacturer, Novo Nordisk, declined to comment.

FTC’s latest announcement follows a similar action in September when regulators challenged more than 100 patents held by drugmakers, including Abbvie, AstraZeneca and Boehringer Ingelheim.

Companies receiving the letters have 30 days to withdraw or update their patent listings, or “certify under penalty of perjury” that they are legitimate, according to the FTC. The patents are registered with the Food and Drug Administration, which reviews and approves new drugs.

The patent challenges are part of a strategy by President Joe Biden to bring down drug prices, including allowing Medicare to negotiate with drugmakers and permitting states like Florida to import cheaper drugs from other countries.

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A certain type of fee is popping up on more and more bills, and experts say it can range anywhere from a couple bucks to $1,000.

“That’s the facility fee. They bill the insurance company $212, but they knock it down to $60.21,” said Paul Paoli, who said he was surprised to see an unexpected $60.21 charge for his last doctor’s appointment.

It wasn’t for his cancer treatment, but rather for a “facility fee” for his hospital visit. The explanation of benefits does not detail what the facility fee covers.  

“It’s not transparent, you know, because most of us are used to a copay and you pay it and you’re down the road, and then now this has come up,” said Paoli.

Facility fees are becoming more common across the country.

Abe Scarr with the Public Interest Research Group of Illinois explained why.

“More and more we’re seeing these mega health systems, hospital systems, and as they grow and have more market power, that’s when we start to see things like this, these arbitrary fees that they’re only able to get away with because consumers don’t really have much choice,” said Scarr.

Scarr said knowing how much the fees may cost can be hard to predict.

“They don’t work in any predictable way. So we’ve seen them as small as $4 and up to $1,000. And they’re often not disclosed until after the fact. So it’s not necessarily a percentage of your bill, or anything tied to any other part of your bill. It’s a tacked-on fee,” said Scarr.

As Paoli learned, asking for the cost of the facility fee at the time you schedule your appointment may not lead to a clear answer.

“I said, ‘What’s the facility fee?’ And he goes, ‘Well, there’s going to be a fee, but I can’t tell you what it is.’ I go, ‘What do you mean?’ ‘Well it depends on how long or this or that,'” said Paoli.

According to a new report from PIRG, 15 states across the country passed laws about facility fees. Illinois and Wisconsin are not included in the list, but last year, Indiana passed a law requiring more transparency about facility fees.

Connecticut, Colorado, Maryland, New York, Ohio, Texas and Washington state all passed laws either restricting or banning facility fees on patient’s medical bills.

Scarr said if you’re billed this fee, you can try disputing it.

“Bring it up with your insurer, contest it with the hospital or provider, and file a complaint with the Consumer Financial Protection Bureau or here in Illinois with the Attorney General’s Office. I can’t say that that’s going to be successful, any of those disputes, but it’s always worth trying,” said Scarr.

After he spoke up, Paoli got his insurance company to cover the entire cost of his facility fee.

“I can afford it, but not everybody can afford it,” said Paoli.

Previously, the task force had said women could choose to start breast cancer screening as young as 40, with a stronger recommendation that they get the exams every two years from age 50 through 74.

The announcement Tuesday from the U.S. Preventive Services Task Force makes official a draft recommendation announced last year. The recommendations were published in the Journal of the American Medical Association.

“It’s a win that they are now recognizing the benefits of screening women in their 40s,” said Dr. Therese Bevers of MD Anderson Cancer Center in Houston. She was not involved in the guidance.

Other medical groups, including the American College of Radiology and the American Cancer Society, suggest mammograms every year — instead of every other year — starting at age 40 or 45, which may cause confusion, Bevers said, but “now the starting age will align with what many other organizations are saying.”

Breast cancer death rates have fallen as treatment continues to improve. But breast cancer is still the second-most common cause of cancer death for U.S. women. About 240,000 cases are diagnosed annually and nearly 43,000 women die from breast cancer.

The nudge toward earlier screening is meant to address two vexing issues: the increasing incidence of breast cancer among women in their 40s — it’s risen 2% annually since 2015 — and the higher breast cancer death rate among Black women compared to white women, said task force vice chair Dr. John Wong of Tufts Medical Center in Boston.

“Sadly, we know all too well that Black women are 40% more likely to die from breast cancer than white women,” Wong said. Modeling studies predict that earlier screening may help all women, and have “even more benefit for women who are Black,” he said.

Here are more details on what’s changed, why it’s important and who should pay attention.

When should I get my first mammogram?

Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk. They should have the X-ray exam every other year, according to the new guidance. Other groups recommend annual mammograms, starting at 40 or 45.

The advice does not apply to women who’ve had breast cancer or those at very high risk of breast cancer because of genetic markers. It also does not apply to women who had high-dose radiation therapy to the chest when they were young, or to women who’ve had a lesion on previous biopsies.

What about women 75 and older?

It’s not clear whether older women should continue getting regular mammograms. Studies rarely include women 75 and older, so the task force is calling for more research.

Bevers suggests that older women talk with their doctors about the benefits of screening, as well as harms like false alarms and unnecessary biopsies.

What about women with dense breasts?

Mammograms don’t work as well for women with dense breasts, but they should still get the exams.

The task force would like to see more evidence about additional tests such as ultrasounds or MRIs for women with dense breasts. It’s not yet clear whether those types of tests would help detect cancer at an earlier, more treatable stage, Wong said.

Does this affect insurance coverage?

Congress already passed legislation requiring insurers to pay for mammograms for women 40 and older without copays or deductibles. In addition, the Affordable Care Act requires insurers to cover task force recommendations with an “A” or “B” letter grade. The mammography recommendation has a “B” grade, meaning it has moderate net benefit.

Maybe it’s also time to rethink drinking?

Moderate drinking was once thought to have benefits for the heart, but better research methods have thrown cold water on that.

“Drinking less is a great way to be healthier,” said Dr. Timothy Naimi, who directs the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia.

Are drinking guidelines changing?

Guidelines vary a lot from country to country but the overall trend is toward drinking less.

The United Kingdom, France, Denmark, Holland, and Australia recently reviewed new evidence and lowered their alcohol consumption recommendations. Ireland will require cancer warning labels on alcohol starting in 2026.

“The scientific consensus has shifted due to the overwhelming evidence linking alcohol to over 200 health conditions, including cancers, cardiovascular diseases and injuries,” said Carina Ferreira-Borges, regional adviser for alcohol at the World Health Organization regional office for Europe.

From Dry January to Sober October to bartenders getting creative with non-alcoholic cocktails, there’s a cultural vibe that supports cutting back.

“People my age are way more accepting of it,” said Tessa Weber, 28, of Austin, Texas. She stopped drinking for Dry January this year because she’d noticed alcohol was increasing her anxiety. She liked the results — better sleep, more energy — and has stuck with it.

“It’s good to reevaluate your relationship with alcohol,” Weber said.

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Wait, moderate drinking doesn’t have health benefits?

That idea came from imperfect studies comparing groups of people by how much they drink. Usually, consumption was measured at one point in time. And none of the studies randomly assigned people to drink or not drink, so they couldn’t prove cause and effect.

People who report drinking moderately tend to have higher levels of education, higher incomes and better access to health care, Naimi said.

“It turns out that when you adjust for those things, the benefits tend to disappear,” he said.

Another problem: Most studies didn’t include younger people. Almost half of the people who die from alcohol-related causes die before the age of 50.

“If you’re studying people who survived into middle age, didn’t quit drinking because of a problem and didn’t become a heavy drinker, that’s a very select group,” Naimi said. “It creates an appearance of a benefit for moderate drinkers that is actually a statistical illusion.”

Other studies challenge the idea that alcohol has benefits. These studies compare people with a gene variant that makes it unpleasant to drink to people without the gene variant. People with the variant tend to drink very little or not at all. One of these studies found people with the gene variant have a lower risk of heart disease — another blow to the idea that alcohol protects people from heart problems.

How many drinks can I have per day?

That depends.

Drinking raises the risk of several types of cancer, including colon, liver, breast and mouth and throat. Alcohol breaks down in the body into a substance called acetaldehyde, which can damage your cells and stop them from repairing themselves. That creates the conditions for cancer to grow.

Thousands of U.S. deaths per year could be prevented if people followed the government’s dietary guidelines, which advise men to limit themselves to two drinks or fewer per day and women to one drink or fewer per day, Naimi said.

One drink is the equivalent of about one 12-ounce can of beer, a 5-ounce glass of wine or a shot of liquor.

Naimi served on an advisory committee that wanted to lower the recommendation for men to one drink per day. That advice was ignored when the federal recommendations came out in 2020.

“The simple message that’s best supported by the evidence is that, if you drink, less is better when it comes to health,” Naimi said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

“I thought I didn’t have any, but I do,” Patricia Adams said. “I found a few and I am going to drive up there and I’m going to have those disposed of.”

Drug Take Back Day offers a chance for you to safely dispose of drugs you no longer need or that are expired — and it’s also an opportunity to help curb the opioid epidemic that’s claimed so many lives.

Adams, a retired social worker, knows firsthand about the dangers of having prescription medications in the home. Awhile back, her young 3- and 5-year-old nieces were visiting.

“And they came downstairs and said to me, ‘Oh, I have candy.’ And I thought, ‘I don’t have candy upstairs.’ And I said, ‘Let me see.’ And of course, it was a pill,” she said.

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Adams shared her story with Jean Moise of D.C.’s Department of Behavioral Health, who is helping to raise awareness about Drug Take Back Day.

“We have an opioid crisis out there right now,” Moise said. “This is one of our main harm reduction strategies. We want to make sure we get the drugs out of the home and out of the hands of youth and children or people that might be inclined to misuse them.”

Last year, on the 25th anniversary of Drug Take Back Day, nearly 600,000 pounds of drugs were collected across the country. In this region, that included:

• In Washington, D.C.: 602 pounds
• Delaware: 4,073 pounds
• Maryland: 10,599 pounds
• Virginia: 16,454
• West Virginia: 4,326 pounds

Adams is urging all her friends and neighbors to check their medicine cabinets like she did.

“Take the opportunity like I am,” she said. “Pay attention, because no matter who’s in your home, no matter how they are loved, you know, we know some of our family have addiction problems, and just pay attention and pass the word on so that they can participate.”

You can drop of any types of pills or liquid medications during Drug Take Back Day. You won’t be asked for ID. There are thousands of dropoff locations across the country Saturday in every state, with 17 locations in D.C.

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So far, the risk to humans remains low, officials said, but scientists are wary that the virus could change to spread more easily among people.

The virus, known as Type A H5N1, has been detected in nearly three dozen dairy herds in eight states. Inactive viral remnants have been found in grocery store milk. Tests also show the virus is spreading between cows, including those that don’t show symptoms, and between cows and birds, according to the U.S. Department of Agriculture.

Starting Monday, hundreds of thousands of lactating dairy cows in the U.S. will have to be tested — with negative results — before they can be moved between states, under terms of a new federal order.

Here’s what you need to know about the ongoing bird flu investigation:

Why is this outbreak so unusual?

This strain of what’s known as highly pathogenic avian influenza has been circulating in wild birds for decades. In recent years, it has been detected in scores of mammals around the world. Most have been wild animals, such as foxes and bears, that ate sick or dying birds. But it’s also appeared in farmed minks. It’s shown up in aquatic mammals, such as harbor seals and porpoises, too. The virus was even found in a polar bear in northern Alaska.

The virus was discovered in ruminants — goats and then dairy cows — in the U.S. this spring, surprising many scientists who have studied it for years.

“When we think of influenza A, cows are not typically in that conversation,” said Richard Webby, an influenza expert at St. Jude Children’s Research Hospital.

How long has bird flu been spreading in cows?

Flu viruses are notorious for adapting to spread among new species, so detection in dairy cows raises concerns it could spread to people, Webby said.

Scientists confirmed the virus in cows in March after weeks of reports from dairy farms that the animals were falling ill. Symptoms included lethargy, sharply reduced milk supply and changes to the milk, which became thick and yellow.

Finding remnants of the virus in milk on the market “suggests that this has been going on longer, and is more widespread, than we have previously recognized,” said Matthew Aliota, a veterinary medicine researcher at the University of Minnesota.

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Under pressure from scientists, USDA officials released new genetic data about the outbreak this week.

The data omitted some information about when and where samples were collected, but showed that the virus likely was spread by birds to cattle late last year, said Michael Worobey, an evolutionary biologist with the University of Arizona.

Since then, it has spread among cattle and among farms, likely through contact with physical objects such as workers' shoes, trucks or milking machines, Worobey said.

And then the cows spread the virus back to birds, he said.

“The genetic evidence is as clear as could be,” Worobey said. "Birds that are sampled on these farms have viruses with clear mammalian adaptations."

What do scientists say about efforts to track the outbreak?

Several experts said the USDA's plans to require testing in cows are a good start.

“We need to be able to do greater surveillance so that we know what's going on,” said Thomas Friedrich, a virology professor at the University of Wisconsin's veterinary school.

Worobey said the ideal would be to screen every herd. Besides looking for active infections, agriculture officials also should be looking at whether cows have antibodies to the virus, indicating past infections, he said.

"That is a really accessible and quick way to find out how widespread this is,” he said.

More testing of workers exposed to infected animals is also crucial, experts said. Some farm owners and some individual workers have been reluctant to work with public health officials during the outbreak, experts have said.

“Increased surveillance is essentially an early warning system,” Aliota said. “It helps to characterize the scope of the problem, but also to head off potentially adverse consequences."

How big a risk does bird flu pose for people?

Scientists are working to analyze more samples of retail milk to confirm that pasteurization, or heat-treating, kills the H5N1 virus, said Dr. Don Prater, acting director of the FDA's food safety center. Those results are expected soon.

While the general public doesn't need to worry about drinking pasteurized milk, experts said they should avoid raw or unpasteurized milk.

Also, dairy farm workers should consider extra precautions, such as masking, hand washing and changing work clothes, Aliota said.

So far, 23 people have been tested for the virus during the outbreak in dairy cows, with one person testing positive for a mild eye infection, CDC officials said. At least 44 people who were exposed to infected animals in the current outbreak are being monitored for symptoms.

What are scientists' concerns for the future?

David O’Connor, a virology expert at the University of Wisconsin-Madison, likened recent bird flu developments to a tornado watch versus a warning.

“There are some of the ingredients that would be necessary for there to be a threat, but we’re not there,” he said. As with a tornado watch, "you wouldn’t change anything about how you live your daily life, but you would maybe just have a bit of increased awareness that something is happening.”

Worobey said this is the kind of outbreak “that we were hoping, after COVID, would not go unnoticed. But it has."

He said ambitious screening is needed "to detect things like this very quickly, and potentially nip them in the bud.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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A London-based dentist has sparked an online debate after advising against three situations that many regard as good times to brush your teeth.

The video, posted by Dr. Shaadi Manouchehri, clinical director at Smart Dental and Aesthetics Clinic in the U.K., has garnered more than 12 million views on TikTok, leaving many incredulous that they were brushing wrong all this time.

She recommends not brushing your teeth directly after vomiting and eating breakfast or sweets.

“I’ve ALWAYS brushed after vomiting,” one shocked TikTok user exclaimed.

“So then why have we ALWAYS been taught to brush out teeth after meals?” one quipped.

“Ah, yes, the three times I want to brush my teeth more than any other time,” another lamented.

So, do other dentists agree with Manouchehri’s assessment? TODAY.com spoke with a few experts to find out.

Acid and brushing your teeth

The argument against not brushing your teeth in certain scenarios is “all about the acid,” Dr. Tien Jiang, assistant professor of oral health policy and epidemiology at Harvard School of Dental Medicine, tells TODAY.com via email.

Many people think cavities come from sugar, but it’s not the direct cause, she says. It’s acid, which can remove the minerals, a process called demineralization, from the tooth’s outer layer, also known as enamel.

“Acid can come from many places — vomit … carbonated drinks, sucking on lemons, etc.,” Jiang explains.

The bacteria that break down the food you eat also release acid. As a result, “it’s natural for the pH of our mouths to drop when we eat, while the bacteria get to work to break down our food.”

Brushing while there’s too much acid in the mouth can damage your teeth.

“People should never brush when your mouth has a very low pH because you don’t want to then scrub that acid into your teeth,” Dr. Beth Caunitz, a dentist in New York City, New York, tells TODAY.com.

Should you brush directly after vomiting?

Many of the experts TODAY.com interviewed recommend waiting to brush your teeth after vomiting.

“Vomit contains stomach acids, which can soften and dissolve the outer layer of your teeth,” says Dr. Diana Nguyen, chief of clinical general dentistry at UCSF School of Dentistry.

“If you brush after vomiting, you’d actually be spreading the acid around to more of your enamel and risk stripping layers of enamel off your teeth with your toothbrush, which can cause the teeth to appear more yellow over time.”

One easy hack that she recommends is a simple homemade rinse.

Add a teaspoon of baking soda to a cup of water, swish it around in the mouth and then spit it out, she says. “This can help buffer the acids and protect your teeth.”

Rinsing after vomiting also reduces how long your teeth will be exposed to acid. A fluoride mouthwash in particular can help re-mineralize the enamel, and then you can brush your teeth sooner, adds Dr. Carlos González-Cabezas, professor and associate dean for academic affairs at the University of Michigan School of Dentistry.

Should you brush after you eat breakfast?

“When we eat, the mouth becomes acidic, as the bacteria in our mouth also feed on the food we eat and metabolize this to an acid, therefore dropping the pH of the mouth,” Manouchehri tells TODAY.com.

“If we brush straight away, we are rubbing this acid onto the teeth, which … can be damaged,” she says.

Our saliva naturally buffers this acidic state over approximately 30 to 60 minutes, so she recommends waiting at least that long to brush.

Jiang agrees: “Waiting 30 (minutes) after eating anything (not just breakfast or sweets) to brush is a normal instruction.”

“In these conditions, tooth enamel is softened, so you could actually damage your teeth by brushing them right after eating,” she explains. “In the meantime, you can drink water and rinse with mouthwash to help clear food particles away from your teeth and gums.”

However, Gonzalez-Cabezas says the impact on the enamel of brushing right after eating is likely minimal. The most important thing is that you brush your teeth at some point every morning.

Should you brush immediately after eating sweets?

Some experts recommend waiting at least an hour after eating sweets to brush your teeth to give your mouth time to wash away the acid, according Mayo Clinic.

Anything with sugar can increase the amount of acid in your mouth, but examples include soft drinks, sports drinks, sour candies, and citrus juices and fruits.

People should also avoid brushing right after having carbonated beverages, as they’re acidic, Caunitz warns.

Instead of brushing your teeth after eating sweets, Caunitz recommends drinking a glass of water because the water will rinse off all the unwanted acid.

However, Gonzalez-Cabezas says that brushing your teeth after eating sweets helps remove potentially harmful sugars that can damage the enamel sooner. Thanks to the toothpaste, brushing right after will also provide fluoride to your teeth, which promotes remineralization.

For those who enjoy sweets or snacking on sugary foods, Nguyen recommends the following:

• Drinking plenty of water
• Using a toothpaste that contains a remineralizing agent like fluoride
• Visiting your dentist regularly to monitor for tooth decay and other dental conditions

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Researchers analyzed prescriptions filled by U.S. pharmacies for the treatment drug buprenorphine. The number of prescribers rose last year after doctors no longer needed to get a special waiver to prescribe the drug, while the number of patients filling prescriptions barely budged.

It may take more than one year to see a bigger increase in patients, said study co-author Dr. Kao-Ping Chua of the University of Michigan Medical School.

“There are so many other barriers to prescribing that we have to address,” said Chua.

The findings were published Wednesday in the New England Journal of Medicine.

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Buprenorphine, which helps with cravings, comes in a pill or film that dissolves under the tongue. It costs about $100 a month. A common version of buprenorphine is Suboxone. Nurse practitioners, physician assistants and doctors can prescribe it.

“People think this is a very complicated medicine and that it requires some sort of complex knowledge to use, when that’s just not the case,” said Dr. Ryan Marino of Case Western Reserve University School of Medicine in Cleveland who has treated hundreds of people with buprenorphine. He had no role in the study.

Barriers include insurance hurdles, price, pharmacies that don’t stock the drug and doctors who believe patients with addiction take up too much time, Chua and other experts said.

“There’s a lot of stigma about this medication, and just in general about patients with opioid addiction,” Chua said.

In addition, some people may not want to try buprenorphine, Chua said. They may think they can’t truly recover if they’re using the opioid-based medication, he said. And it can trigger withdrawal symptoms, especially in people who’ve been using fentanyl, the powerful opioid now dominating the drug supply.

The researchers used a database that captures 92% of filled prescriptions. Comparing 2022 and 2023, before and after the waiver was eliminated, they found 53,600 prescribers at the end of 2023, a 27% increase compared to a year earlier. The number of people filling prescriptions rose about 2% to around 845,000.

The government should look for ways to encourage and even compel hospitals and health systems to provide more treatment, said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health, who was not involved in the study.

More doctors are prescribing buprenorphine, but “getting the bulk of the medical profession to catch up is taking too long,” Saloner said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The U.S. Senate has launched an investigation into the high price of Novo Nordisk‘s popular weight loss and diabetes drugs Ozempic and Wegovy in the United States.

The investigation into the Danish drugmaker was announced by Sen. Bernie Sanders, the Vermont Independent who chairs the Health, Education, Labor and Pensions (HELP) Committee.

“The scientists at Novo Nordisk deserve great credit for developing these drugs that have the potential to be a game changer for millions of Americans struggling with type 2 diabetes and obesity,” Sanders said in a Wednesday letter to CEO Lars Fruergaard Jørgensen.

“As important as these drugs are, they will not do any good for the millions of patients who cannot afford them,” wrote Sanders.

Sanders also laid out in stark terms the dilemma facing American insurers, including the government, given how high the costs are for the potentially life-changing drugs. “If the prices for these products are not substantially reduced they also have the potential to bankrupt Medicare, Medicaid, and our entire health care system,” he wrote.

Sanders noted that Novo Nordisk charges far less for the same drugs in other countries. The company “charges $969 in the United States for one month of Ozempic but just $155 in Canada and just $59 in Germany.”

Wegovy, which is even more expensive than Ozempic, is subject to similarly disparate pricing overseas, wrote Sanders. A study last month said that Ozempic could be manufactured for less than $5 a month.

The powerful progressive senator also made a simple request of the drug company CEO: “Will Novo Nordisk substantially reduce both the list price and the net price of both Ozempic and Wegovy?”

Sanders asked Jørgensen in his letter how the price of the drugs is determined and to make clear the amount the pharmaceutical company spends on research and development. He gave Novo Nordisk until May 8 to answer a series of questions about the drug’s pricing.

Novo Nordisk declined to provide production costs to CNBC following the release of the study and noted that it spent $5 billion on research and development in 2023 and will spend more than $6 billion this year to boost manufacturing for GLP-1s.

In a statement to CNBC Wednesday in response to the letter, Novo Nordisk said the company agrees with Sanders that access to the drugs is important but highlighted the complexities of the healthcare industry.

“It’s easy to oversimplify the science that goes into understanding disease and developing and producing new treatments, as well as the intricacies of U.S. and global healthcare systems. However, the public debate doesn’t always take into account this extremely complex reality,” the company said.

Lisa Pisano’s combination of heart and kidney failure left her too sick to qualify for a traditional transplant, and out of options. Then doctors at NYU Langone Health devised a novel one-two punch: Implant a mechanical pump to keep her heart beating and days later transplant a kidney from a genetically modified pig.

Pisano is recovering well, the NYU team announced Wednesday. She’s only the second patient ever to receive a pig kidney — following a landmark transplant last month at Massachusetts General Hospital – and the latest in a string of attempts to make animal-to-human transplantation a reality.

This week, the 54-year-old grasped a walker and took her first few steps.

“I was at the end of my rope,” Pisano told The Associated Press. “I just took a chance. And you know, worst case scenario, if it didn’t work for me, it might have worked for someone else and it could have helped the next person.”

Dr. Robert Montgomery, director of NYU Langone Transplant Institute, recounted cheers in the operating room as the organ immediately started making urine.

“It’s been transformative,” Montgomery said of the experiment’s early results.

But “we’re not off the hook yet,” cautioned Dr. Nader Moazami, the NYU cardiac surgeon who implanted the heart pump.

“With this surgery I get to see my wife smile again,” Pisano’s husband Todd said Wednesday.

Other transplant experts are closely watching how the patient fares.

“I have to congratulate them,” said Dr. Tatsuo Kawai of Mass General, who noted that his own pig kidney patient was healthier overall going into his operation than NYU’s patient. “When the heart function is bad, it’s really difficult to do a kidney transplant.”

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THE PIG ORGAN QUEST

More than 100,000 people are on the U.S. transplant waiting list, most who need a kidney, and thousands die waiting. In hopes of filling the shortage of donated organs, several biotech companies are genetically modifying pigs so their organs are more humanlike, less likely to be destroyed by people’s immune system.

NYU and other research teams have temporarily transplanted pig kidneys and hearts into brain-dead bodies, with promising results. Then the University of Maryland transplanted pig hearts into two men who were out of other options, and both died within months.

Mass General’s pig kidney transplant last month raised new hopes. Kawai said Richard “Rick” Slayman experienced an early rejection scare but bounced back enough to go home earlier this month and still is faring well five weeks post-transplant. A recent biopsy showed no further problems.

A COMPLEX CASE AT NYU

Pisano is the first woman to receive a pig organ — and unlike with prior xenotransplant experiments, both her heart and kidneys had failed. She went into cardiac arrest and had to be resuscitated before the experimental surgeries. She’d gotten too weak to even play with her grandchildren. “I was miserable,” the Cookstown, New Jersey, woman said.

A failed heart made her ineligible for a traditional kidney transplant. But while on dialysis, she didn’t qualify for a heart pump, called a left ventricular assist device or LVAD, either.

“It’s like being in a maze and you can’t find a way out,” Montgomery explained — until the surgeons decided to pair a heart pump with a pig kidney.

TWO SURGERIES IN EIGHT DAYS

With emergency permission from the Food and Drug Administration, Montgomery chose an organ from a pig genetically engineered by United Therapeutics Corp. so its cells don’t produce a particular sugar that’s foreign to the human body and triggers immediate organ rejection.

Plus a tweak: The donor pig’s thymus gland, which trains the immune system, was attached to the donated kidney in hopes that it would help Pisano’s body tolerate the new organ.

Surgeons implanted the LVAD to power Pisano’s heart on April 4, and transplanted the pig kidney on April 12. There’s no way to predict her long-term outcome but she’s shown no sign of organ rejection so far, Montgomery said. And in adjusting the LVAD to work with her new kidney, Moazami said doctors already have learned lessons that could help future care of heart-and-kidney patients.

Special “compassionate use” experiments teach doctors a lot but it will take rigorous studies to prove if xenotransplants really work. What happens with Pisano and Mass General’s kidney recipient will undoubtedly influence FDA’s decision to allow such trials. United Therapeutics said it hopes to begin one next year.

The case marks the first time the Supreme Court has considered the implications of a state ban since the nationwide right to abortion was overturned. It comes from Idaho, which is among 14 states that now ban abortion at all stages of pregnancy with very limited exceptions.

While members of the high court’s conservative majority expressed concern about pregnant patients’ ability to get emergency care in the state, it was unclear whether any were swayed by the Biden administration’s argument.

The Justice Department says abortion care must be allowed in emergencies that seriously threaten a woman’s health under a federal health care law that requires hospitals accepting Medicare to provide emergency care regardless of patients’ ability to pay.

“How can you impose restrictions on what Idaho can criminalize, simply because hospitals in Idaho have chosen to participate in Medicare?” said Justice Samuel Alito, who wrote the decision overturning Roe v. Wade.

Justices on the high court’s liberal minority, meanwhile, raised sharp questions about whether Idaho’s law was putting women’s health at risk.

“Within these rare cases, there’s a significant number where the woman’s life is not in peril, but she’s going to lose her reproductive organs. She’s going to lose the ability to have children in the future unless an abortion takes place,” said Justice Elena Kagan.

The Biden administration argues that even in states where abortion is banned, federal health care law says hospitals must be allowed to terminate pregnancies in rare emergencies where a patient’s life or health is at serious risk.

Idaho contends its ban has exceptions for life-saving abortions but allowing it in more medical emergencies would turn hospitals into “abortion enclaves.” The state argues the administration is misusing a health care law that is meant to ensure patients aren’t turned away based on their ability to pay.

The Supreme Court has allowed the Idaho law to go into effect, even during emergencies, as the case played out. It makes performing an abortion a felony punishable by up to five years in prison.

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Dueling protests were taking shape outside the court before the start of arguments on Wednesday. “Abortion saves lives,” read signs displayed by abortion rights supporters. Opponents displayed a sign that read, “Emergency rooms are not abortion clinics.”

Doctors have said Idaho’s abortion ban has already affected emergency care. More women whose conditions are typically treated with abortions must now be flown out of state for care, since doctors must wait until they are close to death to provide abortions within the bounds of state law.

Meanwhile, complaints of pregnant women being turned away from U.S. emergency rooms spiked after the Supreme Court overturned Roe v. Wade, according to federal documents obtained by The Associated Press.

Anti-abortion groups blame doctors for mishandling maternal emergency cases. Idaho argues the Biden administration overstates health care woes to undermine state abortion laws.

The justices also heard another abortion case this term seeking to restrict access to abortion medication. It remains pending, though the justices overall seemed skeptical of the push.

The Justice Department originally brought the case against Idaho, arguing the state’s abortion law conflicts with the 1986 Emergency Medical Treatment and Active Labor Act, known as EMTALA. It requires hospitals that accept Medicare to provide emergency care to any patient regardless of their ability to pay. Nearly all hospitals accept Medicare.

A federal judge initially sided with the administration and ruled that abortions were legal in medical emergencies. After the state appealed, the Supreme Court allowed the law to go fully into effect in January.

The Supreme Court is expected to rule by the end of June.

News4 has information families need to know as spring sports season kicks into high gear.

“Now we really are recommending that kids and teenagers get back to, certainly, physical activity and indeed some cognitive or thinking activity sooner rather than later,” said Dr. Christina Johns, a pediatric emergency physician at PM Pediatric Care.

A new study published in the British Journal of Sports Medicine supports that idea. Researchers at Nationwide Children’s Hospital in Ohio found that limiting screen time and returning to school within a week following a concussion helped speed up the recovery process.

“There is some more recent data that suggests that going back to school activity, so, using our brains or what we call cognitive activity, that that should happen earlier as well – that we don’t necessarily need to have our kids not do any homework or not go to school,” Johns said.

For some children, it seems that their symptoms improved when they returned to the classroom, she said.

As kids recover from concussions, which type of activities they do matters, Johns said.

The study found that kids who spend a lot of time on screens, either surfing the internet or playing video games or watching TV, in the first week post-injury seemed to recover more slowly.

“One of the concerns we note is that for children who have had a concussion and who are staying home for a prolonged amount of time, is that they can feel isolated, feel left out of their activities, and that can be difficult. And then they may also be spending more time on their screens, which will add to the eyestrain, the very thing that we are trying to solve,” Johns said.

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What to do if you think your child got a concussion

Concussion signs include a light sensitivity in the eyes, a headache and the person possibly not remembering what happened at the time of injury, Johns said. Nausea and vomiting are possible.

If you think your child suffered a concussion, pull them out of any sports activity immediately. Waiting even a few minutes can increase the risk of more severe symptoms, Johns said.

Then, be sure to get them checked out by a pediatrician or another health care professional.

“It’s not a diagnosis that can be made on an X-ray or on a CT scan. It’s a clinical diagnosis made by a professional,” Johns said.

There is no set time on how long kids should wait before they return to physical or cognitive activity after a concussion. Some kids can return to normal activities within a couple days; others need to wait a week, and it often depends on the severity of symptoms. Most people fully recover within a month, but it’s different for each person and can be delayed in kids who have had previous concussions.

Go here for additional tips.

According to NBC News, in the study of people ages 65 and older, 8.15% of women treated by female physicians died within 30 days, compared with 8.38% of women treated by male physicians. 

Although the difference between the two groups seems small, the researchers say erasing the gap could save 5,000 women’s lives each year. 

The study included nearly 800,000 male and female patients hospitalized from 2016 through 2019. All patients were covered by Medicare. For male hospitalized patients, the gender of the doctor didn’t appear to have an effect on risk of death or hospital readmission.

The data alone doesn’t explain why women fare better when treated by other women. But other studies suggest that women are less likely to experience “miscommunication, misunderstanding and bias” when treated by female doctors, said lead study author Dr. Atsushi Miyawaki, a senior assistant professor of health services research at the University of Tokyo Graduate School of Medicine.

The new research is part of a growing field of study examining why women and minorities tend to receive worse medical care than men and white patients. For example, women and minority patients are up to 30% more likely to be misdiagnosed than white men.

“Our pain and our symptoms are often dismissed,” said Dr. Megan Ranney, dean of the Yale School of Public Health. “It may be that women physicians are more aware of that and are more empathetic.”

Research shows that women are less likely than men to receive intensive care but more likely to report having negative experiences with health care, having their concerns dismissed, and having their heart or pain symptoms ignored, the authors wrote in the new study. Male physicians are also more likely than female doctors to underestimate women’s risk of stroke.

Part of the problem, Miyawaki said, is that medical students get “limited training in women’s health issues.”

Dr. Ronald Wyatt, who is Black, said his 27-year-old daughter recently had trouble getting an accurate diagnosis for her shortness of breath. An emergency room physician told her the problem was caused by asthma. It took two more trips to the emergency room for his daughter to learn that she actually had a blood clot in her lungs, a potentially life-threatening situation.

“There is a tendency for doctors to harbor sexist stereotypes about women, regardless of age, such as the notion that women’s symptoms are more emotional or their pain is less severe or more psychological in origin,” said Wyatt, former chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.

Women seem to experience fewer of these problems when treated by other women.

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For example, a study published JAMA Surgery in 2021 found that women patients developed fewer complications if their surgeon was female. Another JAMA Surgery study published in 2023 found all patients had fewer complications and shorter hospital stays if they were operated on by female surgeons, who worked more slowly than their male counterparts.

Women primary care doctors also tend to spend more time with their patients, Ranney said. Although that extra attention is great for patients, it also means that women see fewer patients per day and earn less, on average, than male doctors.

Dr. Ashish Jha, dean of the Brown University School of Public Health, said several studies suggest that female doctors follow medical evidence and guidelines, and that their patients have better outcomes. 

“There’s lots of variation between women and men physicians,” said Jha, who was not involved in the new study. Women “tend to be better at communication, listening to patients, speaking openly. Patients report that communication is better. You put these things together, and you can understand why there are small but important differences.”

The authors of the study said it’s also possible that women are more forthcoming about sensitive issues with female physicians, allowing them to make more informed diagnoses.

That doesn’t mean that women should switch doctors, said Dr. Preeti Malani, a professor of medicine at the University of Michigan. For an individual patient, the differences in mortality and readmission rates seen in the new study are tiny.

“It would be a mistake to suggest that people need to find physicians of the same gender or race as themselves,” Jha said. “The bigger issue is that we need to understand why these differences exist.”

Malani said she’s curious about what women doctors are doing to prevent patients from needing to be readmitted soon after discharge. “How much care and thought is going into that discharge plan?” Malani asked. “Is that where women are succeeding? What can we learn about cultural humility and asking the right questions?”

Others aren’t convinced that the new study proves a physician’s gender makes a big difference.

Few hospitalized patients are treated by a single doctor, said Dr. Hardeep Singh, a professor at Baylor College of Medicine in Houston and a patient safety researcher at the Michael E. DeBakey VA Medical Center.

Hospital patients are treated by teams of physicians, especially if they need specialist care, in addition to nurses and other professionals, Singh said.

“How often do you see the same doc every day in the hospital?” Singh asked. “The point is that it’s not a one-man or one-woman show. Outcomes are unlikely to depend on one individual, but rather on a clinical team and the local context of care. … One name may appear on your bill, but the care is team-based.”

However, Singh said his research on misdiagnoses shows that doctors in general need to do a better job listening to patients.

Jha said he’d like the health system to learn what women doctors are doing right when they treat other women, then teach all physicians to practice that way.

“We should train everyone to be better at generating trust and being worthy of trust,” Jha said.

Wyatt said the country needs to take several steps to better care for women patients, including “de-biasing training” to teach doctors to overcome stereotypes. The health care system also needs to increase the number of women physicians in leadership, recruit more female doctors and do a better job at retaining them. All physicians also need more understanding of how adverse childhood experiences affect patient health, particularly for women, he said.

“More than once I’ve had white female patients tell me they came to be because I listened and they trusted me,” Wyatt said.

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He lives independently in his own house in Little Falls, New Jersey, where he has resided since 1945.

The supercentenarian requires no help with daily living, so his grandchildren visit him once a week to bring him some groceries and call every other day to check in, but he’s otherwise self-sufficient.

Dransfield is in good health, other than dealing with achy knees and other minor issues, and navigates between the home’s main floor, his bedroom upstairs and the basement where he does his laundry without a problem, his family says.

When asked how he feels at 110, Dransfield jokingly says he’s ready to put on boxing gloves and box.

“I manage to do everything,” he tells TODAY.com. “I drive pretty good.”

“He drives completely fine — better than some other people I see,” Erica Lista, Dransfield’s granddaughter, tells TODAY.com.

She and her brother periodically check Dransfield’s driving to make sure that he’s doing OK. Family, friends and doctors are amazed by his healthy longevity, she says, noting she has more health issues at 49 than her grandfather does at 110.

When Dransfield required an endoscopy recently for a swallowing problem, the medical staff was stunned he’d only had anesthesia once before in his entire life, Lista says. She noticed the anesthesiologist’s hands were shaking when he administered the medicine into a 110-year-old man.

It’s uncommon for men to live to 100 — only 15% percent of centenarians are male, according to the New England Centenarian Study based at Boston University. The reasons are unclear.

The club of supercentenarians — people who live to 110 or older — is even more exclusive. Men make up only about 10% of this age group, the study notes.

The oldest man in the world is currently 111 and lives in England, according to the Gerontology Research Group, which maintains a list of validated supercentenarians. Dransfield is currently the 8th oldest man on the list.

Born on March 28, 1914, Dransfield not only enjoys incredible longevity, but healthy longevity, with a fit mind and body. He says he has never had major diseases, like cancer or heart disease. Dransfield has just always been healthy, and has no headaches or backaches, Lista adds.

“I’ve been very, very, very lucky in my lifetime,” Dransfield told TODAY.com in 2023.

He has one child, three grandchildren and seven great-grandchildren. His wife of 54 years died in 1992.

Many family members, friends and firefighters recently gathered at the firehouse where he once served as chief to celebrate his 110th birthday.

“The craziest part is just how excited people are to talk about him and celebrate him,” Lista says. “It’s just so heartwarming to see how many people think he’s as special as we do.”

Here is what to know about the supercentenarian and his advice for living a long life:

Spend time doing what you love

Dransfield spent more than 80 years serving as a member of the local volunteer fire department and was the chief for a period of time.

When asked what brought him happiness and kept him going in life, he quickly answers: “The fire department. … I met so many friends.”

Lista says her grandfather continued to be a regular at the firehouse as he got older and was part of the “3 to 5 club.”

“After my grandmother passed away, that’s really what kept him going. Every day, he would go to the fire house from 3 to 5, and all the old guys would sit there and hang out. That was like his family,” she notes.

As for Dransfield’s professional life, he worked for 60 years — most of that as an auto parts manager — before retiring in his late 70s: “I still wanted to work, but my wife said, it’s time for you to quit,” he recalls.

Milk does a body good

Dransfield left school after 8th grade and went to work for a dairy farm at 15 to help support his family. He delivered milk for five years and drank as much of it as he wanted, which he attributes to giving him a healthy boost — especially during the Great Depression in the 1930s.

“I was drinking milk and eating well because I worked on a farm. And I often go back and think they gave me a good start in life and for my bones in my body,” Dransfield says.

Milk still plays a role in his life: The supercentenarian credits drinking Ovaltine — a milk flavoring and nutrition supplement — every day after breakfast for his longevity. He’s been so outspoken about it that when he when he turned 100, everyone drank Ovaltine at his birthday party, Lista says.

Stay active

Dransfield didn’t lift weights or exercise in a gym, but he kept moving throughout his life. 

“I was 21 years old when I joined the fire department and that’s the exercise I got every day — answered the fire alarms in Little Falls,” he says.

“I was active and ran out when the alarm went off for 40 years. Then for the next 40 years, (I continued) when I felt like it.”

Structured exercise amuses him. “He laughs at people who jog. He’s like, ‘Where are they running to?’” his granddaughter says.

Enjoy what you eat

The supercentenarian likes Italian food, hamburgers, salad, milk chocolate and other sweets. He drinks a cup of coffee every day and occasionally drinks beer, but doesn’t enjoy other forms of alcohol.

He didn’t exactly follow a Blue Zones diet.

“What’s crazy is he was not careful about his diet,” Lista says.

“He has eaten whatever he wants. He has never watched his weight. He’s never had to lose weight. He’s always been fit.”

At 110, Dransfield still cooks for himself, though that usually means heating up soup on the stove or microwaving prepared meals, Lista notes. He likes to buy meals from a restaurant down the road from his house.

It’s never too late to fix a bad habit

Dransfield started smoking when he was 50 after a fellow firefighter offered him a cigarette and he liked it. But about 20 years later, he quit.

“He told me one day that he was going to just stop smoking,” Lista recalls. “He threw the cigarettes out and that was it. He just never smoked again.”

Stay positive

Dransfield considers himself an optimist. He also has a great sense of humor and likes knowing everybody’s name in town, his granddaughter says.

“Knowing people and loving people makes me live longer,” Dransfield says.

“He always had such a positive upbeat attitude, even when my grandmother passed away. He lived for her, but he was determined to keep on living,” Lista adds.

“I keep positive. I never think any other way when something’s wrong,” Dransfield notes.

“I’m doing fine and I hope the good Lord keeps me that way.”

This story first appeared on TODAY.com. More from TODAY:

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The Equal Employment Opportunity Commission, the agency in charge of enforcing the law, adopted an expansive view of conditions related to pregnancy and childbirth in its proposed regulations, including a controversial decision to include abortion, fertility treatment and birth control as medical issues requiring job protections.

The rules, which were adopted on a 3-2 vote along partisan lines, were published Monday and offer extensive guidelines for addressing more routine difficulties of pregnancy, such as morning sickness, back pain and needing to avoid heavy lifting. Labor advocates say the law will be especially transformative for pregnant women in low-wage jobs, who are often denied simple requests like more bathroom breaks.

Here’s what to know about the law and the EEOC regulations.

WHAT IS THE PREGNANT WORKERS FAIRNESS ACT?

Congress passed the law with bipartisan support in December 2022 following a decade-long campaign by women’s rights and labor advocates, who argued that the 1978 Pregnancy Discrimination Act did little to guarantee women would receive the accommodations they might need at work.

The law stated only that pregnant workers should be treated the same as other employees, not that they deserved special consideration. To get their requests met, many pregnant workers therefore needed to demonstrate they had physical limitations covered under the Americans With Disabilities Act, often creating insurmountable hurdles.

The new law treats pregnancy and related conditions as themselves deserving of “reasonable accommodations” and places the burden on employers to prove “undue hardships” for denying any requests.

The law applies to employers of at least 15 workers. The EEOC estimates it will cover roughly 1.5 million pregnant workers in any given year. The EEOC regulations published April 15 are set to go into effect in June.

WHAT ARE WORKERS ENTITLED TO?

The EEOC’s 400-page document encompasses a wide array of conditions and relevant advice for employers.

It states that workers are entitled to unpaid time off for situations such as prenatal appointments, fertility treatments, abortion, miscarriage, postpartum depression and mastitis, an infection that arises from breastfeeding. This includes workers who are not covered by federal family leave laws and those who have not been on the job long enough to accrue time off.

Workers can ask for flexible working arrangements to deal with morning sickness, such as a later start time, clearance to work from home or permission to carry snacks in workplaces where eating is typically prohibited. If they can’t sit or stand for extended periods due to sciatica, which is common in late pregnancy, they can request a schedule adjustment so their commutes happen during less crowded hours.

The regulations also allow workers to be exempted from tasks such as climbing ladders or heavy lifting. If those duties are essential to their jobs, they can still request a temporary dispensation, according to the EEOC.

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HOW SHOULD WORKERS REQUEST ACCOMMODATIONS?

Employers don’t have to accommodate workers exactly as requested but they must offer reasonable alternatives. They cannot deny a request without clearing a high bar to prove doing so would cause “undue hardships” for the organization’s finances or operations. They cannot force workers to take unpaid leave if a reasonable accommodation is available.

The EEOC emphasizes that it “should not be complicated or difficult” for pregnant workers to request accommodations. Workers don’t have to make requests in writing, use specific words, cite any laws, or in most cases, provide documentation such as doctors’ notes. Employers must respond quickly and have a conversation about how to reasonably accommodate a worker’s needs.

Still, legal experts advise both workers and employers to document the process. A Better Balance, the non-profit that spearheaded the 10-year campaign for the law’s passage, advises workers to familiarize themselves with their legal rights and be as specific as possible about their limitations and the changes they they need.

WHAT DO THE EEOC RULES SAY ABOUT ABORTION?

Workers who believe a request was denied illegally can file a complaint with the EEOC. They have 180 days to do so, though the deadline can be extended in some states.

The EEOC included abortion among the conditions covered under the law. The rules state, however, that employers are not obligated to cover expenses related to the procedure or to offer health insurance that does.

The EEOC regulations argue that including abortion is consistent with the agency’s longstanding interpretation of other laws under Title VII of the 1964 Civil Rights Act, including the Pregnancy Discrimination Act.

But the decision drew condemnation from Republican lawmakers who had championed the law’s passage. The five-member EEOC’s two Republican members voted against the regulations.

In a statement explaining her dissent, Commissioner Andrea Lucas said the agency broadened the scope of the law “to reach virtually every condition, circumstance, or procedure that relates to any aspect of the female reproductive system” in ways that “cannot reasonably be reconciled with the text” of the law.

Melissa Losch, a labor and employment attorney at the New Orleans-based firm McGlinchey Stafford, said she expects the regulations to give rise to further litigation. Losch cited the example of a worker living in a state with a restrictive abortion law requesting time off to undergo the procedure in another state. The EEOC rules provide “no good answer” about whether granting such a request would conflict with restrictive state abortion laws, she added.

ARE WORKERS IN TEXAS COVERED?

On February 27, a federal judge blocked enforcement of the Pregnant Workers Fairness Act for Texas state employees, a ruling that came in response to a lawsuit filed by Texas Attorney General Ken Paxton. Paxton argued the law was unconstitutional because it was part of a spending bill that passed in the House without a majority of members present, and the judge ruled in his favor.

Gedmark, of A Better Balance, said she was optimistic the Biden administration would prevail in its expected appeal of the ruling. In the meantime, federal and private sectors workers in Texas are covered by the law.

But in her dissenting statement, Lucas warned that if the Texas case or any future lawsuits succeed in overturning the law, the EEOC’s divisive rules have “all but extinguished” the chances of a bipartisan effort to reenact it.

WHAT HAS THE LAW’S IMPACT BEEN SO FAR?

Employers have been obligated to abide by the Pregnant Workers Fairness Act since it took effect on June 27, 2023, though the EEOC regulations provided guidance on how to do so.

The law swiftly made a difference to many low-wage workers, according to Gedmark.

A Better Balance, which operates a helpline, has “heard an overwhelmingly positive experience from workers,” she said. Last summer, the organization worked with some women whose employers stopped resisting requests for accommodations as soon as the law took effect, Gedmark said.

Some workers reported their employers were still operating under the old legal framework, handing them pages of disability paperwork to fill out in response to requests.

The EEOC said it received almost 200 complaints alleging violations of the law by the time the fiscal year ended on Sept. 30, 2023.

Gedmark said the success of the law will depend on enforcement and raising awareness.

“If workers don’t know about the law and don’t know about their rights, then it really undermines the purpose of the law,” she said.

WHO authorized the vaccine, made by EuBiologics, which also makes the formulation now used, last week. The new version, called Euvichol-S, is a simplified formula that uses fewer ingredients, is cheaper, and can be made more quickly than the old version.

The vaccine was shown to be help preventing the diarrheal disease in late stage research conducted in Nepal.

WHO’s approval means donor agencies like the vaccines alliance Gavi and UNICEF can now buy it for poorer countries. Leila Pakkala, director of UNICEF’s supply division, said in a statement that the agency will be able to boost supplies by more than 25%.

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Gavi estimated there could be about 50 million doses for the global stockpile this year, compared with 38 million last year.

Dr. Derrick Sim of Gavi called WHO’s authorization “a lifeline for vulnerable communities around the world.”

More is still needed, however: Since January, 14 countries affected by cholera outbreaks have requested 79 million doses. In January, the U.N. agency said the global vaccine stockpile was “entirely depleted” until the beginning of March. As of this week, WHO said there were 2.3 million doses available.

Cholera is an acute diarrhea disease caused by a bacteria typically spread via contaminated food or water. It is mostly seen in areas that have poor sanitation and lack access to clean water. While most people infected with cholera don’t experience symptoms, those with severe cases need quick treatment with intravenous fluids and antibiotics. If left untreated, cholera kills about a quarter to half of people infected.

Since last January, WHO has reported more than 824,000 cholera infections, including 5,900 deaths worldwide, with the highest numbers of cases reported in the Middle East and Africa. The U.N. agency said warming temperatures that allow the cholera bacteria to live longer, have also worsened outbreaks and led to the highest death rates in a decade.

___

“He was telling me, ‘Oh my neck is really hurting me,’” wife Lauren Barchanowicz, 38, of Finleyville, Pennsylvania, tells TODAY.com. “I’m like, ‘I think you should probably get it checked out.’”

The couple visited the emergency room where doctors found an orange-sized mass in his chest. Len Barchanowicz had a thymoma, a type of cancer of the thymus.  

“I thought I was a dead guy, honestly. Even how she presented it to me because she said she couldn’t tell if it was attached to my aorta,” Len Barchanowicz tells TODAY.com. “I thought honestly I was going in for an emergency surgery.”

Neck pain reveals underlying problem

As a mailman in the Pittsburgh area, Len Barchanowicz spends a lot of his time walking. When he began experienced stinging pain in his neck he wondered if he somehow pinched a nerve. Then on a humid August day, he felt like he couldn’t breathe easily.   

“I started having almost like chest pains, but not heart related but above where your heart would be,” Len Barchanowicz says.

At first, he attributed that to the weather, but Lauren Barchanowicz, a nurse, worried something more serious was occurring. She examined him and didn’t think he was having a heart attack. Still, it felt concerning.

“He’s like, ‘Oh it’s getting better,’” Lauren Barchanowicz says. “I’m like, ‘I don’t know. I think you should probably get checked out.’”

At the emergency room, it soon became clear something serious was occurring as doctors ran a slew of tests on him.

“I thought maybe they found like a clog or something was going on heart related,” he says.

While an X-ray didn’t show anything, a doctor had a hunch that something else was occurring and ordered a CT scan with contrast. That test revealed an orange-sized mass nestled in his chest above the heart.

“It was a shock,” Lauren Barchanowicz says.

At first, the oncologists thought he had Hodgkin’s Lymphoma, a type of cancer that begins in the lymphatic system which works to protect the body from infection.

“(When) you read the report on the CT, it is very unclear,” Lauren Barchanowicz says. “The only thing that they could say is there is a big mass.”

The surgical team mentioned something called a thymoma, too, but the diagnosis remained mysterious. His blood test had markers for Hodgkin’s Lymphoma and he no other symptoms consistent with cancer.

“They give you the cancer checklist,” Len Barchanowicz says. “Like, is there is a sudden weight loss? Do you have night sweats? Do you feel nauseated? I wouldn’t be able to check any of them.”

Len Barchanowicz eventually underwent a PET scan, which can determine where cancer is in the body.

“The only thing that lit up with him was literally the little circle right around … the mass,” Lauren Barchanowicz. “We were like, ‘Oh thank God. It’s localized. It’s not spread throughout his body.’”

Soon after, he underwent a video-assisted thoracoscopic surgery (VATS) for doctors to obtain a sample of the tumor to better understand what he had. It was still unclear but doctors had a better idea.

“They said probable thymoma,” Lauren Barchanowicz says.

Thymoma

Cancer of the thymus gland remains “very rare,” Dr. Ranjita Pallavi, a medical oncologist and Len Barchanowicz’s doctor at Allegheny Health Network in Pittsburgh, tells TODAY.com.

“He turned out to have something called a thymoma, which is a tumor that arises from the front of the chest,” says Pallavi. “When we see a mass in that area we’re thinking of something arising from the thymus gland.”

Everyone has a thymus gland, which is part of the immune system, but it works the most during infancy and childhood before becoming dormant, according to past TODAY.com reporting.

Pallavi says these types of tumors tend to be encapsulated, meaning they do not easily spread, and don’t have many symptoms associated with them. Doctors tend to find them incidentally when someone come in with an other unrelated problem. And in some rare cases, there can be symptoms, Pallavi says.

“There’s a proportion of patients where the mass can really get big in size when it starts compressing on the surrounding organs,” she explains. “That’s the time when people actually present with chest pains or shortness of breath.”

In Len Barchanowicz’s case, his tumor remained mostly encapsulated but did spread a little bit, deeming it a stage 2 cancer.

“It was also invading into the surrounding fat,” Pallavi says.

A surgeon removed the 8.7 centimeter mass and 14 lymph nodes leaving clean margins on October 3, 2023.

“He was not given any radiation after surgery,” she says. “For the same reason, because of the very low risk of these tumors coming back, he did not get chemotherapy.”

Len Barchanowicz will need to undergo a chest CT scan every six months for the first two years then yearly for up to eight more years.

“Sometimes the tumors can come back seven, eight years down the line,” Pallavi says. “The surveillance does extend up to 10 years.”

Recovery

Recovering from surgery, which required doctors to crack open his sternum, felt difficult. Len Barchanowicz experienced intense pain.  

“It was a nightmare,” he says. “I was hitting that (pain medicine) button pretty regularly on the hour.”

After two days in the hospital, Len Barchanowicz went home.

“Having good lung capacity and having a good heart, I think that probably helped in my recovery early, too,” he says.

Good news came shortly after, he says. His tumor had not become attached to his aorta or his phrenic nerve, where the cancer sometimes grows, Lauren Barchanowicz notes.

“There was no involvement with the major arteries and he did not have any major bleeding because that was a big concern as well,” she says. “The (surgeon) said … ‘The tumor came out easily and beautifully.”

Len Barchanowicz is struck by how quickly neck pain turned into a serious diagnosis that he luckily overcame. 

“It’s so weird that one day everything’s going great and then you get hit with this,” he says. “I almost have survivor’s guilt.”

By January 2024, Len Barchanowicz was able to return to work and feels grateful for the great care he received from his doctors at Allegheny Health Network and the support of loved ones.

“When something like that happens it hits you like a ton of bricks,” he says. “I was always very blessed with my kids and my wife and I really do live this great life.”

The Barchanowicz family wanted to share his story to help others who might also experience a thymoma because they often felt alone in the experience.

“We just can’t believe that this happened and I don’t want anyone else to feel this way,” Lauren Barchanowicz says.

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“My motivation started to fall,” Lee said this week at the Team USA media summit.

“I could not bend my legs the slightest, I couldn’t squeeze my fingers, my face was swollen,” Lee said, noting she retained 45 pounds in water weight. “I looked like a completely different person. It was very, very miserable.”

She said she lived with constant pain, nausea and lightheadedness.

“We have it under control now,” she said. “We know what to do and the right medication to take.”

The then-18-year-old Lee was thrust into the spotlight at the Tokyo Games when teammate and reigning Olympic champion Simone Biles unexpectedly dropped out in the middle of the team final, citing her mental health. Lee hadn’t been in the original lineup for the U.S. team’s floor exercise but scored a team-best 13.666 to help the Americans claim a silver medal.

A few days later, Lee became the fifth straight American woman to win the Olympic all-around title, using a dazzling set on uneven bars — her signature event — to edge Brazil’s Rebeca Andrade in a tight final that turned Lee into a star.

On to Auburn University she went, but she left the Tigers upon falling ill after her sophomore season last year. She was never a sure thing to come back for Paris, but now she’s expected to make the U.S. team, along with Biles, who is coming back as well.

“Initially I decided I wanted to come back because I really was only getting better and I love gymnastics,” Lee said. “I was not ready to be done and I wanted to prove to myself that I could be better than I was at the last Olympics.”

Lee is working on a new bars move that, if she pulls it off in an international competition, could be named after her in the sport’s Code of Points.

She said she had a strong support system back home in Minneapolis, which helped her get back on the road to the Olympics.

“I was learning my new skill and I was still able to catch it even at less than 100%,” she said. “It made me realize how much better I was than I thought.”

Social media features such as endless scrolling and push notifications are “particularly risky” to young people, whose developing brains are less able to disengage from addictive experiences and are more sensitive to distractions, the American Psychological Association wrote in a report released Tuesday.

But age restrictions on social media platforms alone don’t fully address the dangers, especially since many kids easily find workarounds to such limits. Instead, social media companies need to make fundamental design changes, the group said in its report.

“The platforms seem to be designed to keep kids engaged for as long as possible, to keep them on there. And kids are just not able to resist those impulses as effectively as adults,” APA chief science officer Mitch Prinstein said in a phone interview. He added that more than half of teens report at least one symptom of clinical dependency on social media. 

“The fact that this is interfering with their in-person interactions, their time when they should be doing schoolwork, and — most importantly — their sleep has really important implications,” Prinstein said.

The report did not offer specific changes that social media companies can implement. Prinstein suggested one option could be to change the default experience of social media accounts for children, with functions such as endless scrolling or alerts shut off.

The report comes nearly a year after the APA issued a landmark health advisory on social media use in adolescence, which acknowledged that social media can be beneficial when it connects young people with peers who experience similar types of adversity offline. The advisory urged social media platforms to minimize adolescents’ online exposure to cyberbullying and cyberhate, among other recommendations.

But technology companies have made “few meaningful changes” since the advisory was released last May, the APA report said, and no federal policies have been adopted.

The report did not name any specific social media platforms. But a spokesperson for Meta, the parent company of Facebook, Instagram and WhatsApp, disputed the assertion that there have not been changes instituted on its platforms recently. In the last year, Meta has begun showing teens a notification when they spend 20 minutes on Facebook and has added parental supervision tools that allow parents to schedule breaks from Facebook for their teens, according to a list of Meta resources for parents and teenagers. Meta also began hiding more results in Instagram’s search tool related to suicide, self-harm and eating disorders, and launched nighttime “nudges” that encourage teens to close the app when it’s late.

Prinstein said more is still needed.

“Although some platforms have experimented with modest changes, it is not enough to ensure children are safe,” he said.

TikTok and X, formerly known as Twitter, did not immediately respond to a request for comment. A spokesperson for Snap Inc., which owns messaging app Snapchat, said it appreciated the APA’s recommendations and shares “their concerns about many of the key features of traditional social media.”

“Snapchat was intentionally designed differently than other platforms and most people use it to communicate with their close friends and family,” the spokesperson said in a statement, “That’s why Snapchat doesn’t offer public comparison metrics when you talk with your friends and our content platform is moderated, which means we don’t allow unvetted content to reach lots of people.”

Tuesday’s report comes amid broader concern over the effects of social media on young people. In March, Florida passed a law prohibiting children younger than 14 from having social media accounts and requiring parental consent for those ages 14 and 15. California lawmakers have introduced a bill to protect minors from social media addiction. Dozens of states have sued Meta for what they say are deceptive features that harm children’s and teens’ mental health. 

And last month, a book was published by social psychologist Jonathan Haidt that argues that smartphones and social media have created a “phone-based childhood,” sending adolescents’ rates of anxiety, depression and self-harm skyrocketing. 

The book, “The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness,” has been hotly debated. While it has its detractors, it instantly became a bestseller.

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Prinstein said that it’s up to technology companies to protect their youngest users, but parents can also help. He recommended all devices in a family’s household go on top of the refrigerator at 9 p.m. each night to help kids — and parents — get the amount of sleep they need. He also said there is no harm in limiting or postponing a child’s use of social media.

“We have no data to suggest that kids suffer negative consequences if they delay social media use, or if their parents set it for half an hour a day, or an hour a day,” he said. 

“If anything, kids tell us, anecdotally, that they like to be able to blame it on their parents and say, ‘Sorry, my parents won’t let me stay on for more than an hour, so I have to get off,’” he added. “It kind of gives them a relief.”

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The FDA will continue to actively investigate how WanaBana’s apple cinnamon fruit puree pouches, which were recalled in late October because of high lead levels, became contaminated. However, much of the work the agency has done to ensure no one else buys the applesauce pouches has ended.

The agency has pulled the product from stores and prevented any more of it from being imported into the United States. Two other products made by WanaBana — Schnucks applesauce pouches with cinnamon and Weis cinnamon applesauce — were also recalled and removed from stores.

The WanaBana pouches had been sold at discount retail stores, including Dollar Tree. For several months after the recall, there were reports of it still being on store shelves.

“It would be comforting to see data about how many stores had the products listed as contaminated and to see how they’ve ensured the removal of those products from store shelves,” said Laurie Beyranevand, director of the Center for Agriculture and Food Systems at Vermont Law and Graduate School. “These concerns are especially important given the prevalence of those stores being located in communities with lower incomes.”

The FDA did not immediately respond to a request for additional comment.

The issue will be transferred from the agency’s outbreak response team to its post-investigations unit, where officials will continue to determine exactly how the applesauce pouches became contaminated with lead.

The leading hypothesis is that the cinnamon in the applesauce was contaminated with lead. In February, according to the FDA, Ecuadorian officials identified a cinnamon processor as “the likely source of contamination.”

The processor sourced his cinnamon from Sri Lanka. The Ecuadorian officials said that the cinnamon sticks were lead-free before they were processed, and contaminated after processing.

That cinnamon was then sent to a supplier in Ecuador called Negasmart and, in turn, to a facility, Austrofoods, where the applesauce pouches were produced before being exported to the U.S.

The FDA will continue to review reports of lead poisoning that are voluntarily submitted to it; however, it says there may not be enough information for follow-up.

The FDA’s new focus will largely transition to surveillance and prevention. In March, the agency said it identified more cinnamon products sold at discount retail stores that had elevated lead levels.

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FDA finds ‘extremely high' lead levels in cinnamon at Ecuador plant that made tainted fruit pouches

The FDA, along with the Centers for Disease Control and Prevention, had been working with state health officials to track cases of lead poisoning in the U.S. linked to the pouches.

Because the applesauce pouches have a long shelf life, agency officials were concerned that they may still have been in people’s homes after the recall.

As of March, the CDC said that it had received 519 reports of confirmed, suspected and probable cases of lead poisoning linked to the pouches from 44 states. Many young children were among the people sickened. 

The announcement comes less than a week after FDA Commissioner Dr. Robert Califf testified before a congressional committee in part on the agency’s applesauce response.

He called on Congress to pass legislation that would require food manufacturers to test for lead in imported foods. Although many food manufacturers do test for harmful chemicals in their products, there is no federal requirement for them to do so.

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Nine of the 19 patients were hospitalized, the CDC said. Four “were treated with botulism antitoxin because of concerns that the botulinum toxin could have spread beyond the injection site.”

Botox uses a purified form of a neurotoxin called botulinum toxin that prevents muscles from moving for a period of time. The product is often used to prevent or ease facial wrinkles. When the toxin is found in food, it can lead to widespread paralysis and even death.

But when it is injected carefully, botulinum toxin is generally considered safe. Too much in the wrong places can be damaging, according to the CDC.

Cases have been detected in Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington. No deaths have been reported.

It is unclear whether the reactions were the result of fake products, contamination or poor hygiene practices. The CDC’s investigation is ongoing, the agency said.

The Food and Drug Administration said in a statement Friday that it was involved with the investigation.

Warnings about medical procedures at unregulated med spas are rising. Colorado health officials told NBC News that they’re investigating a case of botulism-like illness after an unlicensed provider injected a patient with what was allegedly botulinum toxin. The Illinois patients received injections from a nurse “who was performing work outside her authority,” according to the state’s Public Health Department.

Problematic reactions to botulinum toxin injections include:

• blurry or double vision
• drooping eyelids
• difficulty swallowing or breathing
• dry mouth
• slurred speech
• fatigue and weakness

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Nutrition advice is ever changing, which can leave consumers uncertain about which foods are actually healthy. NBC News asked nine health experts about the foods they think have been wrongly villainized. Here are some of the items they listed and the benefits people may miss out on if they forgo them entirely.

Eggs are packed with protein

Eggs have been demonized for being high in dietary cholesterol, which health experts once believed could contribute to heart disease, said Dr. Maya Vadiveloo, an associate professor of nutrition at the University of Rhode Island.

But updated science has debunked that notion, showing that dietary cholesterol and blood cholesterol affect heart health differently.

Eating foods high in saturated fat, such as red meat, fried foods and fatty dairy can increase the type of blood cholesterol that raises one’s risk of heart problems, according to the Centers for Disease Control and Prevention. But consuming things with cholesterol, like eggs and shellfish, has little correlation to high cholesterol in the blood or a risk of heart disease.

Despite this shift, many people still view eggs poorly. Vadiveloo said that could also be because of other breakfast foods they’re often paired with.

“When people think of eggs, they also think of bacon and home fries,” she said — items that are high in salt and saturated fat. But on their own, eggs are nutritious, she added.

The American Heart Association says people can enjoy one or two eggs every day as a high-quality source of protein; each egg contains about 6 grams.

Eggs are also a source of vitamin D and choline, a nutrient that plays a role in metabolism, memory and muscle control.

Eggs even have a stamp of approval from the WeightWatchers program, which uses a point system to assign values to each type of food and drink based on its nutritional profile. Fruits, vegetables and lean meats are worth zero points, meaning followers of the diet don’t need to measure their portions. Eggs have been on the “ZeroPoint” list since 2017.

Just don’t fry your potatoes

It’s no secret that how you cook and season food influences how healthy it is. Caroline Susie, a registered nutritionist and spokesperson for the Academy of Nutrition and Dietetics, said potatoes have been demonized because of the unhealthy ways they’re prepared.

“Potatoes are just fantastic. What happens is, unfortunately, we tend to screw them up by not eating the skin or frying or mixing them with everything under the sun, like sour cream and butter and bacon,” Susie said. Such toppings add saturated fat, which should be limited to 13 grams or less per day, according to the American Heart Association.

A 2021 study found that consuming higher quantities of french fries was associated with an increased risk for chronic diseases such as Type 2 diabetes and high blood pressure. But boiled, baked and mashed potatoes weren’t linked to a higher risk of hypertension in that study and were only slightly associated with an increased risk of Type 2 diabetes.

Potato skins are high in fiber, which aids digestion. Potatoes also contain vitamin C and potassium, Susie added.

She advised roasting, baking, mashing or boiling potatoes and seasoning with olive oil, salt, pepper and herbs.

Frozen doesn’t always mean less healthy

Seven nutrition experts bemoaned the common perception that frozen fruits and vegetables are less healthy than their fresh counterparts.

“Frozen vegetables and frozen foods are picked at their pinnacle of nutrient density and then flash-frozen. So in many cases, they retain higher nutrient content than their fresh counterparts,” Vadiveloo said, “particularly when you live in a place that has more seasonal variation and availability.”

Susie said that in addition to retaining their nutrients, frozen vegetables are sometimes cheaper than fresh ones and can help people prevent food waste.

“Sometimes when I buy fresh produce, it essentially just goes to, I joke, the veggie bin graveyard. It just goes there to die,” she said. “But canned and frozen lasts longer.”

A few cups of coffee are not cause for concern

Coffee’s poor reputation comes from its caffeine, which is addictive and can cause jitters or anxiety for some people when overconsumed.

However, the Food and Drug Administration says people can drink up to four or five cups per day. Research shows coffee can contribute to a decreased risk of cancer, heart failure, Type 2 diabetes and even death.

FDA Apr 13

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Vadiveloo said she drinks three to five cups of coffee with milk every day. Studies suggest it can improve cognitive function, she said, so she believes coffee’s benefits outweigh the potential drawbacks of caffeine consumption.

“That’s a myth that I regularly debunk. Because a lot of people will say, ‘Oh, I’m trying to reduce coffee or caffeine.’ And the research just doesn’t support that coffee, particularly if you’re not adding a ton of added sugar or creamer and things like that, has any health risks within a reasonable consumption amount,” Vadiveloo said.

Alicia Henson, the education specialist for the Master of Nutritional Sciences and Dietetics program at the University of California, Berkeley, said the health value of coffee — much like potatoes — depends on what’s added.

“If you’re going to Starbucks and you’re drinking frappuccinos or you’re drinking coffee that has a ton of added sugar and cream to it, then that’s not necessarily a healthy addition,” Henson said.

The type of carbohydrate makes all the difference

Experts said carbohydrates as a whole are often assumed to be unhealthy, in part because of the popularity of low-carb and ketogenic diets. But it’s incorrect to think that all carbs are the same.

“It has to do with the quality of the carbohydrates — so refined versus whole grains,” said Dr. Linda Shiue, an internist and the director of culinary and lifestyle medication at Kaiser Permanente.

Refined grains, such as those used to make processed food like white bread, crackers and pastries, lack the fiber and nutrients that make whole grains healthy, Shiue said. That includes iron and B vitamins. But quinoa, farro and brown rice, for instance, offer protein, magnesium, iron and fiber, which keeps you feeling full.

Dr. Melina Jampolis, a physician nutrition specialist with a private practice in Los Angeles, said she often recommends one particular whole grain to patients as a snack, much to their surprise: popcorn.

Many people associate popcorn with the movie theater version, which is full of salt, butter and sometimes sugar — and often sold alongside a large soda. But when you prepare popcorn at home with just olive oil and spices, Jampolis said, the snack is fibrous and can be part of a balanced diet. Research also shows popcorn contains phenolic acids, a type of antioxidant.

Jampolis added that people shouldn’t fixate on avoiding any one food; instead, it’s best to cultivate a healthy eating pattern that prioritizes whole foods over ultraprocessed items with added sugar.

“That’s what the real experts do,” she said. “We don’t look at single foods necessarily in isolation.”

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Health officials stress that the risk to the public is low and that the U.S. food supply remains safe and stable.

“At this time, there continues to be no concern that this circumstance poses a risk to consumer health, or that it affects the safety of the interstate commercial milk supply,” the U.S. Food and Drug Administration said in a statement.

Here’s what you need to know about bird flu and food:

As of Friday, the strain of bird flu that has killed millions of wild birds in recent years has been found in at least 26 dairy herds in eight U.S. states: Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, Texas and South Dakota.

The virus, known as Type A H5N1, has been detected in a range of mammals over the last few years, but this is the first time it has been found in cattle, according to federal health and animal agencies. Genetic analysis of the virus does not show that it has changed to spread more easily in people, the U.S. Centers for Disease Control and Prevention said.

Agriculture officials in at least 17 states have restricted imports of dairy cattle from states where the virus has been detected, but, so far, government agencies say it’s had little effect on commercial milk production. Officials believe cows likely have been infected by exposure to wild birds, but said cow-to-cow spread “cannot be ruled out.”

Farmers are testing cows that show symptoms of infection, including sharply reduced milk supply and lethargy. Animals that show signs or test positive for illness are being separated from other animals on the farms. The animals appear to recover within two weeks.

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What to know about the latest bird flu outbreak in the US

Apr 2

Largest US fresh egg producer halts production at Texas plant after bird flu found in chickens

U.S. egg producers are watching the situation closely after bird flu was detected in chickens in Texas and Michigan. Millions of birds have been killed, but the FDA said the risk of affected eggs getting into the retail market or causing infections in humans is low because of federal inspections and other safeguards.

Scientists say there’s no evidence to suggest that people can contract the virus by consuming food that’s been pasteurized, or heat-treated — or properly cooked.

“It’s not a food safety concern,” said Lee-Ann Jaykus, an emeritus food microbiologist and virologist at North Carolina State University.

Two people in U.S. have been infected with bird flu to date. A Texas dairy worker who was in close contact with an infected cow recently developed a mild eye infection and has recovered. In 2022, a prison inmate in a work program caught it while killing infected birds at a Colorado poultry farm. His only symptom was fatigue, and he recovered.

Yes, according to food safety experts and government officials.

U.S. producers are barred from selling milk from sick cows and must divert and destroy it. In addition, milk sold across state lines is required to be pasteurized, or heat-treated using a process that kills bacteria and viruses, including influenza.

“We firmly believe that pasteurization provides a safe milk supply,” Tracey Forfa, director of the FDA’s Center for Veterinary Medicine told a webinar audience this week.

The FDA and the CDC are less certain about unpasteurized, or raw, milk sold in many states, saying there’s limited information about the possible transmission of the H5N1 virus in such products.

So far, no herds linked to raw milk providers have reported cows infected with bird flu, but the agencies recommend that the industry not make or sell raw milk or raw milk cheese products made with milk from cows that show symptoms — or are exposed to infected cows.

U.S. health officials have long warned against the risk of foodborne illness tied to raw milk, which the CDC said caused more than 200 outbreaks that sickened more than 2,600 people between 1998 and 2018.

Still, raw milk proponents like Mark McAfee, owner of Raw Farm USA in Fresno, Calif., said the outbreak of H5N1 in commercial cows appears to have spurred higher sales of the products, despite federal warnings.

Only dairy cows, not beef cattle, have been infected or shown signs of illness to date, agriculture officials said.

The largest egg producer in the U.S. temporarily halted operations on April 2 after finding bird flu in its chickens. Cal-Maine Foods culled about 1.6 million laying hens and another 337,000 pullets, or young hens, after the detection.

The company said there was no risk to eggs in the market and that no eggs had been recalled.

Eggs that are handled properly and cooked thoroughly are safe to eat, said Barbara Kowalcyk, director of the Center for Food Safety and Nutrition Security at George Washington University.

“A lot of people like runny eggs. Personally, if I eat an egg, it’s very well cooked,” she said.

Still, Kowalcyk and others cautioned that the situation could change.

“This is an emerging issue and clearly this pathogen is evolving and there’s a lot that we don’t know,” she said. “I do think that everybody is trying to figure it out as quickly as possible.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Therabot, a text-based AI app in development at Dartmouth College, launched in a clinical trial in March with 210 participants. In its conversations with users, the app uses generative AI, the same technology that powers OpenAI’s ChatGPT, to come up with answers and responses. The app also uses a form of AI that learns patterns and has been designed to enable Therabot to get to know and remember a user and provide personalized advice or recommendations based on what it has learned.

There are already a handful of script-based therapy apps and broader “wellness” apps that use AI, but Therabot’s creators say theirs would be the first clinically tested app powered entirely by generative AI that has been specifically designed for digital therapy. 

Woebot, a mental health app that says it has served 1.5 million people worldwide, launched in 2017 in collaboration with interventional scientists and clinicians. Wysa, another popular AI therapy app, in 2022 received a Food and Drug Administration Breakthrough Device designation, a voluntary program designed to speed up development, assessment and review of a new technology. But these apps generally rely on rules-based AI with preapproved scripts.

Nicholas Jacobson, an assistant professor at Dartmouth College and a clinically trained psychologist, spearheaded the development of Therabot. His team has been building and finessing the AI program for nearly five years, working to ensure responses are safe and responsible. 

“We had to develop something that really is trained in the broad repertoire that a real therapist would be, which is a lot of different content areas. Thinking about all of the common mental health problems that folks might manifest and be ready to treat those,” Jacobson said. “That is why it took so long. There are a lot of things people experience.”

The team first trained Therabot on data derived from online peer support forums, such as cancer support pages. But Therabot initially replied by reinforcing the difficulty of daily life. They then turned to traditional psychotherapist training videos and scripts. Based on that data, Therabot’s replies leaned heavily on stereotypical therapy tropes like “go on” and “mhmm.” 

The team ultimately pivoted to a more creative approach: writing their own hypothetical therapy transcripts that reflected productive therapy sessions, and training the model on that in-house data. 

Jacobson estimated that more than 95% of Therabot’s replies now match that “gold standard,” but the team has spent the better part of two years finessing deviant responses.

“It could say anything. It really could, and we want it to say certain things and we’ve trained it to act in certain ways. But there’s ways that this could certainly go off the rails,” Jacobson said. “We’ve been essentially patching all of the holes that we’ve been systematically trying to probe for. Once we got to the point where we were not seeing any more major holes, that’s when we finally felt like it was ready for a release within a randomized controlled trial.”

The dangers of digital therapeutic apps have been subject to intense debate in recent years, especially because of those edge cases. AI-based apps in particular have been scrutinized.

Last year, the National Eating Disorders Association pulled Tessa, an AI-powered chatbot designed to provide support for people with eating disorders. Although the app was designed to be rules-based, users reported receiving advice from the chatbot on how to count calories and restrict their diets. 

“If [users] get the wrong messages, that could lead to even more mental health problems and disability in the future,” said Vaile Wright, senior director of the Office of Health Care Innovation at the American Psychological Association. “That frightens me as a provider.”

With recruitment for Therabot’s trial now complete, the research team is reviewing every one of the chatbot’s replies, monitoring for deviant responses. The replies are stored on servers compliant with health privacy laws. Jacobson said his team has been impressed with the results so far.

“We’ve heard ‘I love you, Therabot’ multiple times already,” Jacobson said. “People are engaging with it at times that I would never respond if I were engaging with clients. They’re engaging with it at 3 a.m. when they can’t sleep, and it responds immediately.”

In that sense, the team behind Therabot says, the app could expand access and availability rather than replacing human therapists.

Jacobson believes that generative AI apps like Therabot could play a role in combating the mental health crisis in the United States. The nonprofit Mental Health America estimates that more than 28 million Americans have a mental health condition but do not receive treatment, and 122 million people in the U.S. live in federally designated mental health shortage areas, according to the Health Resources and Services Administration.

“No matter what we do, we will never have a sufficient workforce to meet the demand for mental health care,” Wright said. 

“There needs to be multiple solutions, and one of those is clearly going to be technology,” she added.

During a demonstration for NBC News, Therabot validated feelings of anxiety and nervousness before a hypothetical big exam, then offered techniques to mitigate that anxiety custom to the user’s worries about the test. In another case, when asked for advice on combating pre-party nerves, Therabot encouraged the user to try imaginal exposure, a technique to alleviate anxiety that involves envisioning participating in an activity before doing it in real life. Jacobson noted this is a common therapeutic treatment for anxiety.

Other responses were mixed. When asked for advice about a breakup, Therabot warned that crying and eating chocolate might provide temporary comfort but would “weaken you in the long run.”

With eight weeks left in the clinical trial, Jacobson said that the smartphone app could be poised for additional trials soon and then broader open enrollment by the end of the year if all goes well. Beyond other apps essentially repurposing ChatGPT, Jacobson believes this would be a first-of-its-kind generative AI digital therapeutic tool. The team ultimately hopes to gain FDA approval. The FDA said in an email that it has not approved any generative AI app or device. 

With the explosion of ChatGPT’s popularity, some people online have taken to testing the generative AI app’s therapeutic skills, even though it was not designed to provide that support. 

Daniel Toker, a neuroscience student at UCLA, has been using ChatGPT to supplement his regular therapy sessions for more than a year. He said his initial experiences with traditional therapy AI chatbots were less helpful.

“It seems to know what I need to hear sometimes. If I have a challenging thing that I’m going through or a challenging emotion, it knows what words to say to validate how I’m feeling,” Toker said. “And it does it in a way that an intelligent human would,” he added.

He posted on Instagram in February about his experiences and said he was surprised by the number of responses.

On message forums like Reddit, users also offer advice on how to use ChatGPT as a therapist. One safety employee at OpenAI, which owns ChatGPT, posted on X last year how impressed she was by the generative AI tool’s warmth and listening skills.

“For these particularly vulnerable interactions, we trained the AI system to provide general guidance to the user to seek help. ChatGPT is not a replacement for mental health treatment, and we encourage users to seek support from professionals,” OpenAI said in a statement to NBC News.

Experts warn that ChatGPT could provide inaccurate information or bad advice when treated like a therapist. Generative AI tools like ChatGPT are not regulated by the FDA since they are not therapeutic tools.

“The fact that consumers don’t understand that this isn’t a good replacement is part of the problem and why we need more regulation,” Wright said. “Nobody can track what they’re saying or what they’re doing and if they’re making false claims or if they’re selling your data without your knowledge.”

Toker said the personal benefits of his experience with ChatGPT outweigh the cons.

“If some employee at OpenAI happens to read about my random anxieties, that doesn’t bother me,” Toker said. “It’s been helpful for me.”

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Memorial Hermann-Texas Medical Center said in a statement Friday that their ongoing investigation found that a doctor had made “inappropriate changes” in a database for people awaiting liver transplants. Memorial Hermann’s statement didn’t name the doctor, but the University of Texas Health Science Center at Houston, or UTHealth Houston, issued a statement defending Dr. Steve Bynon, calling him ”an exceptionally talented and caring physician” with survival rates that are “among the best in the nation.”

Bynon is an employee of UTHealth Houston who is contracted to Memorial Hermann. UTHealth said its faculty and staff, including Bynon, are assisting with the inquiry into Memorial Hermann’s liver transplant program and are “committed to addressing and resolving any findings identified by this process.”

Memorial Hermann said a doctor made changes to the donor acceptance criteria, which includes factors like the age and weight of the deceased donors. The hospital said the inappropriate changes were only made to the liver transplant program, but since there is shared leadership over both the liver and kidney transplant programs, they inactivated both.

Shutting down the transplant programs during the investigation is prudent with an “allegation of this magnitude,” said Karen Maschke, a research scholar at the Hastings Center, a medical ethics think tank. “They know full well that when they put a program on hold, it’s going to have a really serious impact on patients. So I think they probably don’t make that decision lightly.”

Such allegations of manipulating a transplant waiting list can undermine the public’s trust in the organ allocation system, Maschke said.

Without fairness, transparency and accountability in a transplant program “you lose, the trust of patients, but also donors,” Maschke said, “because, donors won’t want to provide organs if they think that the institution is not going to manage the allocation system fairly.”

Memorial Hermann said in a statement Thursday to The New York Times that a doctor in the liver transplant program admitted to changing patient records. The newspaper identified the doctor as Bynon.

The U.S. Department of Health and Human Services said in a statement that they were “working across the department to address this matter.” The Organ Procurement and Transplantation Network, or OPTN, said it “cannot comment on any potential or ongoing review of a member organization.”

The death rate for people waiting for a liver transplant at Memorial Hermann was higher than expected in recent years, according to publicly available data from the Scientific Registry of Transplant Recipients, which evaluates U.S. organ transplant programs.

Data from OPTN shows that four patients died or became too ill for a transplant in 2021, 11 in 2022, 14 in 2023, and so far this year, that number was at five.

The UTHealth statement said that Bynon treated “patients with higher-than-average acuity and disease complexity.”

Memorial Hermann said they’ve been working with patients who were on the lists to ensure they get the care they need, including being transitioned to another transplant program if necessary. Memorial Hermann also said it was working with UTHealth Houston to make changes so they can reactivate the program under different leadership.

It’s the first time this virulent strain of bird flu — referred to as highly pathogenic H5N1 — has been detected in cows and the first documented cow-to-human transmission of an avian influenza virus, according to the U.S. Centers for Disease Control and Prevention. It’s also only the second case of bird flu in a human in the United States.

Is bird flu a problem now?

The multi-state bird flu outbreak is affecting cows in over a dozen dairy farms across the country. Although health officials are on high alert, the current risk to the general public is low, experts say.

While the thought of “bird flu” may sound alarming and stoke COVID-19 pandemic fears, influenza among birds is not new.

“The current bird flu strain that we’re concerned with, H5N1, has actually been circulating around the world for quite some time,” Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, tells TODAY.com.

What is bird flu?

Bird flu is a disease caused by infection with avian influenza type A viruses. Avian influenza A viruses occur naturally among wild aquatic birds, such as geese, ducks and swans, says Schaffner, but they can also circulate among domestic poultry.

“Bird flu viruses occasionally get into other mammalian species (like pigs). We’ve all heard of swine flu,” Schaffner says. Avian influenza A viruses can also infect horses, bats and dogs, per the CDC — rarely, they spread to humans.

“More recently, we have seen an increase of infections in cattle,” Dr. Hilary M. Babcock, infectious disease specialist at Washington University of St. Louis and BJC Healthcare, tells TODAY.com.

This is the first time the avian influenza strain of highly pathogenic H5N1, which causes severe and often fatal disease in birds, has been found in cows. “That’s pretty unusual,” says Schaffner. However, this H5N1 strain does not seem to be making cows very sick, he adds.

What states have bird flu?

Highly pathogenic avian influenza viruses (which include the strain of H5N1 that’s currently spreading) have been detected in the U.S. in wild aquatic birds, commercial poultry and backyard bird flocks beginning in January 2022, according to the CDC.

Overall, 48 states have reported cases of highly pathogenic H5N1.

The current outbreak of H5N1 affecting cows has spread to eight states so far, per the U.S. Department of Agriculture. As of April 11, cases have been reported among dairy herds in:

• Texas
• Kansas
• Michigan
• New Mexico
• Idaho
• Ohio
• North Carolina
• South Dakota

Currently, only one human in Texas is known to have contracted H5N1 in this outbreak, the experts say.

There have been only two human cases of H5N1 in the U.S. ever, says Babcock — the first case was detected in Colorado in 2022 in a person who had direct contact with infected poultry.

As H5N1 surveillance increases, experts anticipate the number of cases among cows to increase. “We’re looking harder now and finding more cases (among cattle) that even 10 years ago would have gone undetected,” says Schaffner.

The risk to the general public in the U.S. is low, the experts say. For people exposed due to their line of work, the risk is considered “low-to-moderate,” the World Health Organizagtion said in a statement.

How does the bird flu spread to humans?

“Every once in a while, a bird flu virus can get into a human, but that’s rare,” says Schaffner. Avian influenza viruses can spread from infected birds to humans in a few ways, according to the CDC:

• Directly from an infected bird
• From environments contaminated with avian influenza virus
• Through an intermediate host, such as an animal

Infected birds can shed the virus in their saliva, nasal secretions, mucus and feces. People can become infected when a large enough amount of the virus gets into the mouth, nose, eyes or is inhaled, says Schaffner.

Transmission to humans typically occurs through close contact with infected birds without protective gear. It can also occur if a person touches contaminated surfaces and puts their hands in their eyes or mouth, or if they breathe in droplets from the air, per the CDC.

It is not immediately clear how the dairy cow infected the person in Texas, the experts note. The only other person who contracted H5N1 in the U.S. was directly involved in the culling of birds presumed to be infected with H5N1, says Babcock.

Sporadic cases of H5N1 in humans have been reported around the world, often in rural areas where people live closely with poultry or other birds. According to the WHO, since 2003 there have been 889 cases and 463 deaths caused by H5N1 in 23 countries.

Once the bird flu gets into a human, “it is almost never spread to anyone else,” says Schaffner. However, “there are ultra-rare instances of transmission from a person very sick with bird flu to a family member or caregiver.”

When does happen, it does not lead to continued spread between people “because the virus doesn’t have the (genetic) capacity to spread easily from person to person,” says Schaffner.

“This strain of bird flu has been around for about a decade and it still has not picked up this capacity to spread readily from person to person, thankfully. … That should be a matter of reassurance, but also keep us in public health on alert,” says Schaffner.

No human-to-human spread has occurred with the contemporary H5N1 viruses currently spreading in birds, the CDC said.

Can you get bird flu through eggs?

There is no evidence that people can get bird flu from food that’s been properly prepared and cooked, and it is safe to eat eggs, chicken and beef, and drink pasteurized milk, the experts say.

“We have not seen cases that have been from ingesting animal products or animals that may have been infected,” says Babcock.

The infected dairy cow herds that have been detected are in quarantine and their milk is being destroyed, says Schaffner.

In a statement, the USDA said the commercial milk supply in the U.S. remains safe. The U.S. Food and Drug Administration said it does not currently have concerns about the safety of pasteurized milk products, including pasteurized cheese.

“The pasteurization process in the U.S. keeps our milk supply very safe,” says Babcock. Pasteurization heats the milk to a high enough temperature to kill bacteria and viruses, including influenza.

Drinking unpasteurized or “raw” milk, which is increasingly trendy, is associated with various infectious disease hazards, says Schaffner. “I discourage people from drinking raw milk,” he adds.

The risk of humans becoming infected by eating eggs from poultry with H5N1 is low, says the FDA, and there safeguards in place to identify infected poultry and remove their eggs from the market.

It’s possible for products from infected animals to end up in the food supply, says Babcock, but the risk to humans is still very low. Properly storing and cooking food further reduces that risk.

Although beef cattle are not involved in this outbreak, Schaffner recommends cooking beef to a safe internal temperature. The FDA recommends cooking eggs until the white and yolk are firm.

“There are other reasons that you shouldn’t eat raw eggs (or meat), because these can carry lots of different pathogens,” says Babcock.

What happens if a human gets the bird flu?

Bird flu infections in humans can range in severity, the experts note. Some people have zero or only mild symptoms, while others develop severe disease, according to the CDC. “It can be a serious infection with a high mortality rate,” says Schaffner.

The Texas patient had a mild infection, with eye redness as the only symptom, the CDC said. “It was not even a respiratory infection. It was … conjunctivitis or pink eye,” Schaffner notes.

The patient was treated with flu antivirals and is recovering. “We have antiviral medications, the same ones we use to treat regular flu, that work against this avian influenza strain,” Schaffner says.

The other human case of H5N1 in the U.S. in 2022 was a mild infection as well, Babcock adds.

Symptoms of bird flu in humans

According to the CDC and experts, the reported signs and symptoms of avian influenza in humans include:

• Fever
• Cough
• Runny nose
• Muscle or body aches
• Headache
• Fatigue
• Shortness of breath
• Eye redness or inflammation (conjunctivitis)
• Diarrhea
• Nausea

Bird flu in humans may look similar to a regular flu or upper respiratory infection, says Babcock, or a person may have no obvious symptoms. It can also lead to pneumonia, respiratory failure and other complications. “There’s a full range,” she adds.

There is no way to diagnose an infection with bird flu by symptoms alone, the CDC says. Laboratory testing is required.

Can you recover from bird flu?

Yes, you can recover from bird flu. The human recently infected in Texas was treated with flu antivirals and is recovering. The Colorado patient infected in 2022 also recovered.

Globally, bird flu symptoms have ranged from mild to severe, resulting in death in some cases, according to the CDC.

How to prevent spread of bird flu

Although the risk of getting bird flu is low, the CDC recommends the following protective actions:

• Avoid visiting poultry farms if possible
• If visiting poultry farms, wear a mask and avoid touching birds
• Avoid sick or dead birds
• Maintain good hand hygiene
• Do not eat raw or undercooked poultry
• Visit a doctor if you become sick after contact with birds

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The paper, published Friday in JAMA Health Forum, is the first to focus specifically on the contraception choices of women and men ages 18 to 30 after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the constitutional right to abortion. 

Studying this age group is important because they are “much more likely to have an abortion and … to experience sterilization regret relative to their older counterparts,” said co-author Jacqueline Ellison, an assistant professor at the University of Pittsburgh School of Public Health.

A vasectomy is a routine procedure in men that blocks sperm from reaching semen. Tubal ligation or sterilization involves cutting, tying or removing the fallopian tubes to prevent sperm from reaching the eggs. 

It’s difficult to prove the Dobbs decision caused a rise in women and men undergoing permanent birth control. But the new study used a particular statistical approach that, Ellison said, strongly suggested the increase in sterilization procedures flowed from the Supreme Court’s decision and the subsequent actions in 21 states to ban or further restrict access to abortion.

Ellison and her fellow researchers analyzed medical record data from academic medical centers and affiliated clinics nationally from two periods: Jan. 1, 2019, to May 31, 2022, before Dobbs, and from June 1, 2022, to Sept. 30, 2023, after Dobbs.

They found that there were roughly 58 more tubal ligations per 100,000 outpatient visits after Dobbs and 27 more vasectomies per 100,000 visits. 

“There was a lot of fear and anxiety … around whether people were going to be able to get an abortion that they needed or wanted and even fears about being able to access contraception down the road,” she said.

Young women may have felt a greater urgency to act than their male partners in the wake of policy changes because pregnancy disproportionately affects them, said Dr. Angela Liang, a clinical assistant professor of obstetrics and gynecology at the University of Michigan who was not involved in the new study. There are medical risks during pregnancy and during delivery, “such as postpartum hemorrhage and the need for a cesarean section,” Liang said, adding that much of the burden after pregnancy also falls on women.

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The new study had limitations. For one thing, the data was not broken down by state, which can reveal a more detailed response to policy changes.

In Michigan, for example, the Supreme Court’s decision allowed a 1931 law making all abortions a felony to be enforced. Two and a half months later, a permanent injunction blocked the law, and, two months after that, Michigan voters passed an amendment to the state constitution that established an individual right to reproductive freedom.

Liang and several colleagues analyzed electronic health records at one health care institution in Michigan and found that requests for tubal sterilizations surged in the months after the Dobbs decision and then returned to baseline.

“The decrease back to baseline after 6 months may have been due to the demand being met, a decreased sense of urgency after abortion access was temporarily protected, or crisis fatigue,” they wrote in JAMA last year. 

Using medical records to analyze contraception decisions captures the decisions of only patients and not those who have not sought medical care during the time period studied. 

In a recent study, Megan Kavanaugh, the principal research scientist at the Guttmacher Institute, and a colleague analyzed survey data of reproductive-age women in four states, finding an increase in condom use but no significant changes in permanent contraception methods. The report from Guttmacher, a research and policy organization that supports abortion rights, was published in a medical journal in February.

This broader population of women “may not necessarily have very strong attitudes about pregnancy prevention,” said Kavanaugh, who was not involved in the new study.

A more complete examination of contraception choices in the United States will be available at the end of the year when the federally sponsored National Survey of Family Growth releases data from January 2022 through December 2023, Kavanaugh said. The pandemic interrupted the survey, and the latest available data is from 2019.

“It is the gold standard for much of the data we track around sexual and reproductive health care and their outcomes,” she said.

This story first appeared on NBCNews.com. More from NBC News:

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She’ll probably miss his high school graduation.

Death doesn’t frighten her much. The 65-year-old didn’t cry when she learned two months ago that the cancerous tumors in her liver were spreading, portending a tormented death.

But later, she received a call. A bill moving through the Illinois Legislature to allow certain terminally ill patients to end their lives with a doctor’s help had made progress.

Then she cried.

“Medical aid in dying is not me choosing to die,” she says she told her 17-year-old grandson. “I am going to die. But it is my way of having a little bit more control over what it looks like in the end.”

That same conversation is happening beside hospital beds and around dinner tables across the country, as Americans who are nearing life’s end negotiate the terms with themselves, their families and, now, state lawmakers.

Vermont Jan 5

Terminally ill Conn. woman ends her life on her own terms in Vt. after legal battle

Vermont May 2, 2023

Vermont Allows Out-of-Staters to Use Assisted Suicide Law

At least 12 states currently have bills that would legalize physician-assisted death. Eight states and Washington, D.C., already allow it, but only for their own residents. Vermont and Oregon permit any qualifying American to travel to their state for the practice. Patients must be at least 18 years old, within six months of death and be assessed to ensure they are capable of making an informed decision.

Two states have gone in the opposite direction. Kansas has a bill to further criminalize those who help someone with their physician-assisted death. West Virginia is asking voters to enshrine its current ban into the state constitution.

That patchwork of laws has left Americans in most states without recourse. Some patients choose to apply for residency in a state where it’s legal. Others take arduous trips in the late-stage of disease to die in unfamiliar places and beds, far from family, friends and pets.

It was late at night when Rod Azama awoke to his wife crawling on the floor, screaming. Pain from her cancer had punched through the heavy morphine dose.

“Let me die,” screamed his wife, Susan.

As Rod rushed to hold her, the cries faded to repeated mumbles. “Heaven,” she said, again and again.

Susan, 68, pieced through her life’s belongings — family heirlooms, photos, an antique spinning wheel — touching the memories a final time. Then she decided where their next lives would be.

She said goodbye to her constant sidekick, Sunny, a fluffy Maltipoo.

Then the couple traveled to Oregon.

The issue is contentious. Opponents have moral objections with the very concept of someone ending their life. Even with safeguards in place, they argue, the decision could be made for the wrong reasons, including depression or pressure from family burdened by their caretaking.

“It’s normalizing suicide, and it’s incentivizing individuals to end their lives,” said Danielle Pimentel of Americans United for Life. Pimentel raised concerns that pain isn’t the top reason people choose an early departure, adding that policy should focus on bettering end-of-life care.

Two national organizations lobbying for the bills argue it’s about autonomy and compassion, some power over one’s preordained exit.

“It comes down to the right of an individual to control their own end of life decisions free from government intervention or religious interference,” said Goeff Sugerman, national campaign strategist Death with Dignity.

Even though it’s illegal in most states, a 2018 Gallup poll showed more than two-thirds of Americans support the practice.

Only a small fraction of Americans across the country, about 8,700, have used physician-assisted death since Oregon became the first state to legalize it in 1997, according to the advocacy group Compassion & Choices.

The organization successfully sued Oregon and Vermont over their residency requirements in the last two years and are using the courts to expand access. California has a bill before lawmakers that would allow out-of-staters to access the procedure. Three states, including Colorado, have proposals to expand in-state access, such as allowing advanced practice registered nurses, not just doctors, to prescribe the medication.

As Robertson discussed the topic with her grandson, he got teary eyed. If it became legal in Illinois tonight, would his grandmother be gone tomorrow? How does it differ from suicides that left empty seats at his school?

Robertson reassured him it would be the very last option as she embarks on new chemotherapy treatment. Then she explained the safeguards.

Typically, two doctors must confirm that a patient has six months to live. The patient must verbally request it twice with a waiting period that varies by state, and submit a written request with witnesses. At three meetings, a physician assesses the patient to ensure they are able to make an informed decision. The patient can be referred to a psychologist for an assessment if there are concerns.

Patients must take the medication themselves. They lose consciousness within a few minutes, and die usually within a few hours.

Eventually the teenager met her eyes. “Granny, I support whatever you choose to do,” he said.

When Gary Drake, a jovial businessman from Florida, received a diagnosis that lung, bone and kidney cancer would end his life within six months, he didn’t deliberate long.

The 78-year-old flew to Oregon in February, after beginning a Facebook post with “RIP.”

“I love you all, say a prayer for me, and I’ll see you on the other side,” the Feb. 13 post read.

His son, Mitch, flew to Oregon to meet with his father. They said their goodbyes, then Drake drank the medicine.

As they played his song request, “Toes” by Zac Brown Band, Drake put the cup down and sang.

“I got my toes in the water, ass in the sand

Not a worry in the world, a cold beer in my hand

Life is good today

Life is good today.”

Then he fell asleep.

___

Bedayn is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

“Our water has been cloudy and bubbly and looks milky,” said Barrett, who blames fluoride, a mineral that communities across the nation have for decades added to the water supply to help prevent cavities and improve dental health.

“I don’t want fluoride in my nothing!” said Barrett, echoing a growing number of people who not only doubt the mineral’s effectiveness but also believe it may be harmful despite decades of data pointing to public health and economic benefits.

In February, the Board of County Commissioners in Union County, whose seat is Monroe, voted 3-2 to stop adding fluoride to drinking water at the Yadkin River Water Treatment Plant, the only water source wholly owned and operated by the county. But the decision came after heated discussions among residents and county officials.

“My children had the blessing of growing up with fluoride in their water and … they have very little dental issues,” said Commissioner Richard Helms ahead of the vote. A fellow commissioner saw it differently: “Let’s stop putting something in the water that’s meant to treat us, and give people the freedom to choose,” said David Williams.

Barrett’s water comes from the city of Monroe, not the Yadkin facility. So, for now, she will continue to drink water enhanced with fluoride. “I’m suspicious as to why they add that to our water,” she told KFF Health News.

It is a scenario playing out nationwide. From Oregon to Pennsylvania, hundreds of communities have in recent years either stopped adding fluoride to their water supplies or voted to prevent its addition. Supporters of such bans argue that people should be given the freedom of choice. The broad availability of over-the-counter dental products containing the mineral makes it no longer necessary to add to public water supplies, they say. The Centers for Disease Control and Prevention says that while store-bought products reduce tooth decay, the greatest protection comes when they are used in combination with water fluoridation.

The outcome of an ongoing federal case in California could force the Environmental Protection Agency to create a rule regulating or banning the use of fluoride in drinking water nationwide. In the meantime, the trend is raising alarm bells for public health researchers who worry that, much like vaccines, fluoride may have become a victim of its own success.

The CDC maintains that community water fluoridation is not only safe and effective but also yields significant cost savings in dental treatment. Public health officials say removing fluoride could be particularly harmful to low-income families — for whom drinking water may be the only source of preventive dental care.

“If you have to go out and get care on your own, it’s a whole different ballgame,” said Myron Allukian Jr., a dentist and past president of the American Public Health Association. Millions of people have lived with fluoridated water for years, “and we’ve had no major health problems,” he said. “It’s much easier to prevent a disease than to treat it.”

According to the anti-fluoride group Fluoride Action Network, since 2010, over 240 communities around the world have removed fluoride from their drinking water or decided not to add it.

One needs only to look to Union County to see just how intense discussions can be. Usually when the commissioners meet on the first floor of the Government Center in downtown Monroe, there are more vacant seats than attendees. But sessions about the prohibition of fluoride in public water supplies were packed, and residents who signed up to speak were divided.

One person who came to the microphone on Feb. 5 compared water fluoridation to a seat belt. It does not “prevent the car crash, but it limits the harm done,” he said. Another argued that there is no proof fluoride is safe or effective. “It’s a significant potential milestone to reverse 60-plus years of poisoning the public,” he said, using an unproven claim often made by opponents of fluoridation.

Fluoride opponents claim the mineral is responsible for everything from acne to high blood pressure and thyroid dysfunction to bone cancer.

The National Institutes of Health acknowledges that, when ingested in extremely large amounts, fluoride from dental products or dietary supplements can cause nausea, vomiting, abdominal pain, diarrhea, bone pain, and even death in extremely rare cases.

Infants and children who receive too much fluoride can develop discoloration or small dents in their teeth. In adults, consumption of excessive fluoride for extended periods can lead to skeletal fluorosis, a very rare condition that causes joint pain and stiffness, weak bones, muscle loss, and nerve problems.

However, the recommended dosage in drinking water has always been small. In 2015, the Department of Health and Human Services lowered the optimal fluoride concentration from 1.2 milligrams per liter to 0.7 mg/L.

Juneau, Alaska, voted to remove fluoride from its drinking water in 2007. A study published in the journal BMC Oral Health in 2018 compared the dental records of children and adolescents who received dental care for decaying teeth four years before and five years after the city stopped adding fluoride to the water. Cavity-related procedures and treatment costs were significantly higher in the latter group, the study found.

Portland, Oregon, is the largest city in the nation that has consistently refused to fluoridate its drinking water. Voters have repeatedly rejected measures to add it, first in 1956 and the latest time in 2013.

Despite the strong recommendation of local doctors and dentists, voters in Wichita, Kansas, have rejected adding fluoride to the water several times, most recently in 2012.

The Brushy Creek Municipal Utility District in Williamson County, Texas, had been adding fluoride to its water system since 2007 but ended the practice in December.

In 2016, Collier County, Florida, commissioners opted not to remove fluoride from the water system. But they unanimously reversed that decision following a 2023 Health Freedom Bill of Rights county ordinance in response to covid-19 “to safeguard the healthcare rights and freedoms of Collier County residents.”

The State College Borough Water Authority in Pennsylvania stopped adding fluoride to the water of its 75,000 customers in March 2023. Officials used claims often cited by fluoride opponents, such as potential environmental contamination, concerns about medical freedom, and possible adverse health effects, like the potential for the appearance of faint white lines on the teeth and lowered IQ for babies.

A study published in JAMA Pediatrics in 2019, conducted in six Canadian cities, associated fluoride exposure during pregnancy with lower IQ scores in children. But the study was based on self-reporting and has been criticized for its perceived methodological shortcomings.

In 2016, several consumer advocacy groups, including the Fluoride Action Network, Food & Water Watch, and Moms Against Fluoridation, petitioned the EPA to end water fluoridation under the Toxic Substances Control Act, alleging that significant research showed fluoride was neurotoxic at the doses now used. The same group filed a federal lawsuit against the EPA the following year, after the agency denied their citizen petition.

During a 10-day bench trial in San Francisco that concluded in mid-February, the two sides debated the risks and areas of uncertainty. If Senior U.S. District Judge Edward Chen determines water fluoridation presents an “unreasonable risk” to human health, the EPA will be forced to create a rule regulating or banning water fluoridation in the U.S. A decision is expected soon.

For the time being, decisions about whether to fluoridate community water systems are still made primarily at the local level, which Barrett hopes will change.

“Of all things, they want our teeth healthy when basic needs of housing and food are lacking.”

One of the world’s most contagious diseases, measles can lead to potentially serious complications. The best defense, according to experts? Get vaccinated.

Here’s what to know about the year — so far — in measles.

How many measles cases has the U.S. seen this year?

Nationwide, measles cases already are nearly double the total for all of last year.

The U.S. Centers of Disease Control and Prevention documented 113 cases as of April 5. There have been seven outbreaks and most of U.S. cases — 73% — are linked to those flare-ups.

Still, the count is lower than some recent years: 2014 saw 667 cases and 2019 had 1,274.

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Why is this a big deal?

The 2019 measles epidemic was the worst in almost three decades, and threatened the United States' status as a country that has eliminated measles by stopping the continual spread of the measles virus.

The CDC on Thursday released a report on recent measles case trends, noting that cases in the first three months of this year were 17 times higher than the average number seen in the first three months of the previous three years.

While health officials seem to be doing a good job detecting and responding to outbreaks, “the rapid increase in the number of reported measles cases during the first quarter of 2024 represents a renewed threat to elimination,” the report’s authors said.

Where is measles coming from?

The disease is still common in many parts of the world, and measles reaches the U.S. through unvaccinated travelers.

According to Thursday’s report, most of the recent importations involved unvaccinated Americans who got infected in the Middle East and Africa and brought measles back to the U.S.

Where were this year’s U.S. measles outbreaks?

Health officials confirmed measles cases in 17 states so far this year, including cases in New York City, Philadelphia and Chicago.

More than half of this year's cases come from the Chicago outbreak, where 61 people have contracted the virus as of Thursday, largely among people who lived in a migrant shelter.

How does measles spread?

Measles is highly contagious. It spreads when people who have it breathe, cough or sneeze and through contaminated surfaces. It also can linger in the air for two hours.

Up to 9 out of 10 people who are susceptible will get the virus if exposed, according to the CDC.

Measles used to be common among kids. How bad was it?

Before a vaccine became available in 1963, there were some 3 million to 4 million cases per year, which meant nearly all American kids had it sometime during childhood, according to the CDC. Most recovered.

But measles can be much more than an uncomfortable rash, said Susan Hassig, an infectious disease researcher at Tulane University.

“I think that people need to remember that this is a preventable disease," Hassig said. “It is a potentially dangerous disease for their children.”

In the decade before the vaccine was available, 48,000 people were hospitalized per year. About 1,000 people developed dangerous brain inflammation from measles each year, and 400 to 500 died, according to the CDC.

Is the measles vaccine safe? Where do vaccination rates stand?

The measles, mumps and rubella (MMR) vaccine is safe and effective. It is a routine and recommended childhood vaccine that is split into two doses.

Research shows it takes a very high vaccination rate to prevent measles from spreading: 95% of the population should have immunity against the virus.

During the COVID-19 pandemic, national vaccination rates for kindergartners fell to 93% and remain there. Many pockets of the country have far lower rates than that. The drop is driven in part by record numbers of kids getting waivers.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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Sgt. Terrika Hooks, a paramedic with D.C. Fire and EMS, is part of the team helping raise awareness about CPR and having AEDs in more places.

She’s trained to save lives, but when her father suffered a heart attack, she wasn’t there, and nobody nearby knew CPR or had access to an AED. She and her mother, Tracey Hooks, believe her father would still be with them if there had been an AED nearby or if someone knew CPR.

“Well, he could have had a second chance,” Tracey Hooks said.

D.C. is offering a $400 rebate to businesses and organizations that install an AED and register it with the District. AEDs typically cost between $800 and $1,400.

The focus will be getting more AEDs east of the Anacostia River, where there’s a huge disparity not only in AEDs but also survival rates when someone goes into cardiac arrest. The PulsePoint app, which shows the locations of registered AEDs, illustrates the lack of devices east of the river.

“And remarkably, still, over the last several years, the survival rate from cardiac arrest among African Americans is less than half that of whites,” D.C. Fire and EMS Medical Director Dr. Robert Holman said. “And some of this gap in AED use is simply due to access.”

Any AED purchased in the past 90 days also qualifies for the rebate.

Former NBA star guard Nate Robinson says he “doesn’t have long to live” if he doesn’t receive a kidney transplant.

“I know that I don’t have long if I can’t get a kidney,” Robinson told Jake Nisse of Daily Mail. “I know I’m not going to have long to live. So I just want to make the best of it as much as I can.

“Some people’s body reject dialysis. And thank God that mine accepts it and I can live… if I didn’t go to dialysis, I wouldn’t live probably longer than a week or two. So it’s serious, can’t miss a day. I go in for four hours, three days a week, four hours a day. And they clean my blood to get my toxins out. And they help me out a lot because that’s how I’m living.”

Robinson told the “Playmaker” podcast that he learned he would eventually face kidney failure later in life due to high blood pressure when he was with the New York Knicks in 2006.

The warning didn’t stop Robinson from captivating NBA fans with an electric career, though.

Robinson, 39, played 11 seasons in the NBA for eight different teams, including the Knicks, Celtics, Thunder, Warriors, Bulls, Nuggets, Clippers and Pelicans. Robinson made a name for himself in New York, becoming the first player in history to win the Slam Dunk Contest three times.

In 2022, he announced he had been suffering from kidney failure since 2018.

Robinson shared that his disease causes frequent, painful vomiting to the point where it he is often hospitalized.

Along with dialysis, a strict diet has become an important part of maintaining his health.

“It’s a whole bunch you got to watch,” he said. You got to have measurements of everything that you eat and drink. You can’t have too much, you can’t have too [little].

“I changed my diet, just try to eat better, staying away from a lot of processed foods, just trying to eat fruits and grilled food, grilled chicken and grilled fish, just healthier stuff. That’s the way I can survive and stay alive as long as I can.”

Despite the gravity of his prognosis, Robinson is keeping his disease in perspective knowing that others in his position aren’t as fortunate.

“I don’t take it for granted,’ he said. I just stay as humble as I can, and I just thank God for every opportunity… every day is a blessing to be alive and to be able to do what I do every day.

“Because some people, they go in for kidneys, go into the hospital, and they never come out.”

The three cases — which took place in late 2022 and early 2023 — were caused by a fungus called Sporothrix schenckii. 

The report comes as the CDC is monitoring the spread of a similar fungal infection, also in cats, in South America. That infection is spread by a related fungus called Sporothrix brasiliensis and hasn’t been detected in the United States.

Sporotrichosis — the illness caused by a Sporothrix infection — is rare in the U.S., but not unheard of. It’s generally picked up through contact with sharp plants that can pierce the skin like rose thorns, which is how it earned the moniker “rose gardener’s disease.” Sporotrichosis tends to cause a skin infection that’s very slow to heal, but it isn’t contagious, according to the CDC.

When cats are infected, however, they carry a very high fungal load, meaning their wounds have a higher risk of spreading the infection to other cats, dogs and people, said Ian Hennessee, an epidemic intelligence service officer at the CDC and the lead author of the report.

“They get these awful wounds on their face, in their nasal cavities and on their paws, and those lesions are full of these fungi,” Hennessee said.

Usually, the infections don’t rise to a level of concern among public health officials.

“The only reason this particular case came to the attention of the health department was because of the human involvement,” said Dr. Erin Petro, a state public health veterinarian at the Kansas Department of Health and Environment in Topeka. “That piqued our interest.”

The first case was in an indoor-outdoor cat who had a wound on her paw that didn’t heal with antibiotics. She spread the infection to a veterinary technician through a scratch, puncturing the tech’s glove and the skin beneath. Several months later, a second cat from the same household also got sick. 

Neither the first cat nor the vet tech were immediately diagnosed with the fungal infection, delaying how quickly they were given antifungal drugs. The vet tech was put on an antifungal for eight months and her infection cleared. The first cat also got an antifungal, but she eventually got sicker and her owners had her euthanized. The second cat was treated much faster and recovered.

“The good news is that this fungal infection is treatable and cats can be cured if a diagnosis is made early,” said Dr. Arturo Casadevall, a microbiologist and chair of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, who was not involved with the report. 

However, he added, “these infections take a long time to get better.” 

The Kansas Department of Health and Environment suspects there was at least one other cat on the property that was infected, a stray cat with face lesions that died on the property but was not tested. 

Sporothrix in Brazil

Most infections in cats, and sometimes dogs, end like the second cat’s story, Petro said: “They get treated and it goes away.”

What’s more, S. schenckii infections are rarely spread by cats. 

That’s not the case in South America, where the S. brasiliensis species is much more contagious. 

That species spreads rapidly among cats and has been known to infect people who were simply around infected cats, but did not come into contact with any wounds. According to Hennessee, these cases may have been due to the fungus being on surfaces and a person touching those surfaces and then their eyes or noses, but that is unclear. 

The fungus was discovered in southeastern Brazil, but has since spread to other countries in South America. From 1998 to 2016, more than 4,500 human cases, contracted from cats, were reported, the CDC says.

The cases in Kansas raised concerns that S. braziliensis could be the culprit, but testing revealed it was the other species.

“We are not sounding the alarm that Sporothrix schenckii is nearly as much of a concern as Sporothrix brasiliensis,” Hennessee said. 

“We know it’s a possibility that we could one day see Sporothrix brasiliensis cases in the U.S.,” he said. “We want to raise awareness without making folks too alarmed.”

Petro expects there are many more S. schenckii infections that occur every year that don’t get attention, either because the fungal infection isn’t reported, or because it isn’t diagnosed in the first place. 

Most fungal infections in the U.S. are unreportable, meaning the CDC doesn’t keep track of how many cases there are. Sporotrichosis is among them. 

“There is a big problem with fungal diseases but they tend to run under the radar,” said Casadevall.

Hennessee said the report is meant to raise awareness among veterinarians and pet owners so cases of sporotrichosis can be caught before they spread between cats or jump to people. But the infections are still thought to be rare and not serious in the U.S. 

“If you have an outdoor cat that has a lesion that has not healed, you should at least ask their veterinarian if it could be a fungus,” Casadevall said. “You have to think about it.”

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The change in season often means a change in skincare routine. While a complete overhaul isn’t necessary, there are some adjustments to make when it comes to products to use.

“We don’t need our heavy, thick moisturizers that we needed in winter, but we are not quite ready to transition to a really lightweight product that we favor in the summertime,” said Dr. Randa Khoury, a dermatologist with Kaiser Permanente.

She says when it comes to spring skincare, moisturizers are still needed, even if it’s not as cold or as dry out anymore.

“We still want to think about protecting our skin barrier, and good choices for this time period are to look for moisturizers that say ‘oil free’ or ‘non-comedogenic,’ which means it won’t clog the pores,” Khoury said.

Khoury says to always use sunscreen with SPF 30 to 50. She prefers mineral sunscreens, which come in a range of tints and colors or clear.

“You still need a sunscreen every day, even if you’re not spending as much time outside doing winter sports, for which sunscreen is super important,” she said. “As we transition to the warmer months, we do start to spend more time out in sun exposed areas, and we definitely need sunscreen even more.”

And if using anti-aging products like retinol, she says it’s okay to keep using it during the warmer months, but with added protection from the sun.

“If you’ve already found something fabulous that works for you, by all means keep using it,” Khoury said. “But if it is something that contains a retinol or something that contains an acid that can make your skin a little more sensitive to sun, remembering to take proper precautions using sun protective clothing and appropriate sunscreens.”

She also suggested using acid-based products in the daytime rather than the nighttime.

And when it comes to the order of layering products on skin, here’s what dermatologists recommend:

“No. 1: your cleanser,” she said. “You want to start with washing your face. No. 2: your actives, and actives are going to be the things that we’re using to change the way our skin looks, feels and behaves. So, if you’re using a retinol, if you’re using a glycolic acid, a vitamin C, anything that we would consider an active that goes on clean skin, that goes on second. And then the final step, step No. 3, is going to be your sunscreen moisturizer. So, I love a combo product for the springtime. That’s a two-in-one. It’s going to give your skin some of that barrier protection and also give you fabulous sun protection. Now, if you’re a splitter instead of a grouper and you like to use a separate moisturizer and sunscreen, that’s the order: moisturizer first followed by sunscreen.”

Khoury tells patients to look for products that are water-based rather than oil-based in a more humid environment so it won’t clog pores.

If there are any skin concerns, be sure to talk to a dermatologist to come up with a personalized treatment plan.

But besides adding flavor, condiments can also add salt, fat and sugar to healthy food if people pour or spread them on too enthusiastically, dietitians say.

There are countless condiments, classic and new, and the list keeps growing. Some Americans now use a half-dozen sauces at a meal, amounting to a “condiment invasion,” The Wall Street Journal recently reported.

“In general, I’m pro-condiment if it helps you eat healthier foods,” says registered dietitian Natalie Rizzo, nutrition editor for TODAY.

“For example, if you only like tofu with soy sauce on it, then add the condiment to entice you to eat more of this healthy plant-based protein. Or if you like to make spicy cauliflower with hot sauce, go ahead and use it to eat more of this cruciferous veggie.”

But if you love mayonnaise and add a few tablespoons of it to a meal, it can drastically increase the calories and saturated fat, she warns.

“Condiments change the nutrition equation. Of course, how much you use is going to be the biggest game changer,” Lisa Young, a registered dietitian in New York and author of “Finally Full, Finally Slim,” tells TODAY.com.

“A little bit goes a long way.”

What are basic condiments?

A condiment is “something used to enhance the flavor of food,” especially a pungent seasoning, according to Merriam-Webster’s definition.

Popular choices in the U.S. include:

• Mustard
• Ketchup
• Mayonnaise
• Relish
• Barbecue sauce
• Salsa
• Hot sauce
• Soy sauce
• Vinegar
• Wasabi or horseradish

Some people consider guacamole and hummus condiments, but foods that can be eaten on their own generally don’t count as a condiment, chefs told The Kitchn.

Condiment nutrition

Every condiment is different, so it’s important to read the label to check the serving size and nutrition facts, both dietitians advise.

Soy sauce and salsa are higher in salt, while mayonnaise is higher in calories, Rizzo says. Ketchup, barbecue sauce and relish all have added sugar.

You can taste the sweetness, but people don’t realize one tablespoon of ketchup has a teaspoon of sugar, Young notes. “Ketchup is something we put on so many foods. It becomes a quantity thing that you want to make sure that you watch,” she adds.

What are the benefits of condiments?

Besides being an easy way to boost taste, condiments can also make a meal more satisfying — potentially helping people to make better choices and eat less in the long run, Young notes.

“If you eat something you like, you’re satisfied and you stop. The thought is psychologically, you’re satisfied,” she says.

Steamed chicken is healthy but bland, so a bit of barbecue sauce will give it that flavor someone might need to choose it over a less nutritious option, Young points out.

Some condiments can add a little bit of nutrition: Salsa, for example, is made with tomatoes and onions — two vegetables that are beneficial to health, Rizzo points out.

What is the healthiest condiment?

Vinegar was the top pick of both dietitians. Drizzling it over beef, poultry or vegetables can boost taste without adding many calories.

“It doesn’t have any added salt, sugar or fat, and you don’t need a lot of it to get a really strong flavor,” Rizzo says.

Vinegar is fermented, good for the gut and adds a pungent taste, Young adds. Fruit vinegars made from wine or apple cider are rich in polyphenols — beneficial compounds found in plants — and organic acids, and can be a good source of antioxidants, studies have found.

Salsa was another top choice since it’s made from mostly tomatoes and plant-based ingredients, which means it has lycopene — a powerful antioxidant — and other health benefits, the dietitians say.

Mustard can also be a healthy pick, adding lots of flavor without many calories or sugar, Young says. But it can be salty, so people with high blood pressure should be careful about eating too much.

What is the least healthy condiment?

Mayonnaise, because it has a good amount of saturated fat, Rizzo says.

Since it’s high in fat and calories, mayonnaise would be the least healthy condiment to choose if you’re watching weight, Young adds. But if you’re a mayo fan, it’s OK to have it; just watch how much you eat.

“If you love mayo, have mayo, but then limit your guacamole” and other high-fat additions to a meal, she advises. “It’s not in the category of butter or cream.”

If sugar is a concern, ketchup and barbecue sauce are the worst condiments, both dietitians say. “The first ingredient on a lot of BBQ sauces is sugar,” Rizzo notes.

The main message is to use condiments wisely: Pick the one you like the best, add a bit to your meal and don’t go overboard. If you’re drowning your roasted veggies in condiments, you’re probably going way over the daily recommendation for salt, sugar and saturated fat, Rizzo cautions.

“It’s always best to look at the recommended serving size on the label. Sometimes you may want a little bit more than the recommendation and that’s fine, but don’t do it every time,” she says.

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IVF is a medical procedure in which an egg is fertilized by sperm in a lab or elsewhere outside of the body, and the fertilized eggs, or embryos, are then placed into the body, according to the Mayo Clinic.

In February 2024, IVF was at the center of much discussion when the Alabama Supreme Court ruled that frozen embryos created through IVF were considered children under state law. This halted IVF procedures around the state until a law was passed to protect IVF providers in March. It shined a light on the legacy of this procedure and the women involved in its creation who have given families a pathway to having children when there was none.

Many women scientists played a role in the development of IVF, from Miriam Menkin in the 30s to Georgeanna Seegar Jones in the late 70s and 80s, Margaret Marsh, a historian of reproductive medicine and reproductive sexuality at Rutgers University, and Dr. Wanda Ronner, a professor of clinical obstetrics and gynecology at the University of Pennsylvania, tell TODAY.com.

“They were all pioneers in in this area, along with the people they worked with,” Marsh says. As research partners to the men developing IVF at the time, the women involved in the formation of IVF were instrumental to the treatment so many people rely on today. “These men could not have been successful without these women,” Ronner notes.

Jones’ work, for example, led to the birth of the first baby born in the U.S. from IVF, Elizabeth Carr. Carr tells TODAY.com she considers Jones to be “the brains” behind the Jones Institute, the IVF clinic in Norfolk, Virginia, where she was born.

“She’s really the one (who) figured out all the hormone protocols that we all know so well now that are involved in IVF,” Carr says. “Throughout her career, she never gave up on this idea of trying to solve this problem of infertility. So, I’m forever eternally grateful to her for that.”

In honor of Women’s History Month, read on to learn about some of the women who helped make IVF possible.

Miriam Menkin

Menkin started working with Harvard gynecologist Dr. John Rock from the late 1930s to 1950s. Together they determined exactly how fertilization occurs in women — something unknown at the time, Marsh and Ronner, who have co-authored several books about the history of reproductive health, said.

Rock, along with embryologist Arthur Hertig, conducted two pioneering studies focused on IVF, Marsh said, the first of which determined exactly when the human embryo forms during conception. (Rock also played a major role in the development of the birth control pill.)

The second part of Rock’s research agenda “could not have been done without the assistance of Miriam Menkin, who was his lab tech,” Marsh said. Menkin’s role in the experiment was to retrieve eggs from women who were undergoing surgical procedures, Marsh said.

“She would be the one standing outside of the operating room, waiting to receive this egg,” Marsh said. Then, using sperm donated from fellows or medical students, Menkin would go to a nearby lab and try to fertilize the egg — “an egg you can’t even see,” Marsh points out.

Menkin began her attempts to fertilize an egg in 1938, using 138 eggs that resulted in 47 inseminations over the course of six years, Marsh said. Menkin and Rock eventually became the first people to fertilize an egg in vitro, or outside of the body, in 1944.

“Menkin was absolutely imperative to Rock’s success. Without her, Rock would not have been able to achieve this. He was the surgeon, he was taking out the tissue, but she was the person in the lab, trying to get these eggs fertilized,” Marsh said.

“Menkin was one of probably hundreds of unsung women scientists,” Marsh points out. Some had doctorate degrees and others, like Menkin, didn’t. But, she stands out in history because she was recognized early-on. Rock made it a point to recognize her work, something which wasn’t common at the time.

Because of her ground-breaking work, Menkin was listed as first author on their research article.

Jean Purdy

After Rock and Menkin’s article was published in Science, a medical journal, in 1944, showcasing the results of their IVF experiment, British researchers Robert Edwards, a biologist, and Patrick Steptoe, a gynecologist, began working on using IVF to conceive a baby.

Edwards’ research assistant and technician, Jean Purdy, would go on to play a vital role in this work in 1968. Purdy, who was trained as a nurse, began teaching herself embryology as she worked with the pair, Marsh says, and the three combined their research in 1973.

Purdy was responsible for combining the egg with the sperm and fertilizing the embryo, which was a tough task. “(Purdy and the team) tried many different mechanisms to get a pregnancy through IVF, but they were not succeeding,” Marsh said.

But, by 1978, Louise Brown became the first baby in the world who was born through IVF on July 25, thanks to Edwards, Steptoe and Purdy’s work.

“In England, there was a lot of skepticism about (IVF). They said they weren’t sure that it could be done,” Marsh explained. The public feared those born via IVF would somehow be different than those who weren’t.

Steptoe, Edwards and Purdy went on to found an IVF clinic in 1980, when Purdy was about 35 years old. But she died shortly thereafter from melanoma, just before she turned 40.

“She was very young and extremely talented,” Marsh notes.

Edwards, one of Purdy’s two research partners, was later awarded the Nobel Prize for physiology or medicine for his work developing IVF in 2010, by then both Purdy and Steptoe had died.

“I think that the situation is that today there’s a lot of behind-the-scenes folks in medicine and science that really don’t get recognition at all,” Marsh said. “I think that was the case then, and that was the case now.”

“She made an incredibly important contribution,” Marsh said of Purdy. “Edwards and Steptoe always told everybody that she was an equal partner.”

Georgeanna Jones

Georgeanna Jones had her first major discovery in medical school and became a distinguished reproductive endocrinologist who would play a vital role in the development of IVF in the U.S., Marsh said.

Jones worked alongside her husband Howard Jones at Johns Hopkins University, where they shared an office and even a desk at times, until they were forced into mandatory retirement by the university when they turned 65.

According to Marsh’s research, the pair were not ready to retire and were offered positions at a brand new medical school, Eastern Virginia Medical School in Norfolk, Virginia. The day the couple drove down to Virginia for their new jobs was the same day the first IVF baby, Louise Brown, was born.

Coincidentally, Marsh said, the couple had mentored Robert Edwards, the British biologist who worked with Purdy and Steptoe in the U.K., when he was trying to learn how to fertilize eggs.

When a reporter asked Howard Jones if a baby could be born from IVF in the U.S., he and his wife began working on accomplishing an IVF birth in 1978, though they did have opposition from the anti-abortion movement concerned with the morality of IVF.

The pair had the backing from their medical school and opened an IVF clinic, which resulted in the first baby born in the U.S. from IVF on Dec. 28, 1981 — Elizabeth Carr.

“There were very few women in reproductive endocrinology in this time — very few women who were IVF pioneers — and she was one,” Marsh said of Georgeanna Jones.

During this time was a number of other women IVF pioneers working throughout the 1980s like Jones, Marsh says. There was Anne Colston Wentz, whose team at Vanderbilt University was the fourth program in the U.S. that had a successful IVF birth in 1983.

PonJola Coney was a fellow at Pennsylvania Hospital, which had its first IVF birth in 1984. Coney was one of the only Black American IVF pioneers at the time, according to Marsh’s research, and she went on to direct the first IVF program in Oklahoma at the University of Oklahoma.

Elizabeth Carr

Carr was the first baby born via IVF in the U.S.

Now, 42-year-old patient advocate living in Massachusetts, she tells TODAY.com that she’s known about IVF for as long as she can remember — and even before then, as she notes she attended her first press conference when she was just three days old.

Carr’s mother experienced three ectopic pregnancies while trying to have children, and after going to a check up, her OBGYN slipped her a copy of a paper talking about IVF and said, while it had only been done in England, it could be something for her to consider, Carr says.

“Both of my parents figured, what did they have to lose? They didn’t have a child as it was, so they figured this could be another shot,” Carr says. “So they figured it was worth taking a step.”

Carr was born in December 1981 with armed guards outside of her hospital room and nursery due to the controversy of her birth, according to the Wall Street Journal.

“I truly don’t remember when I first heard somebody speak out against IVF. Obviously, I feel like that’s always been there as well, and my parents had me under pretty tight security because of the controversy back then,” Carr says. “I guess there’s always been the naysayers, but I just don’t put too much stock into their argument because I think there’s probably nothing more natural than people wanting to build the family of their dreams.”

For the first few years of Carr’s life, she says she attended IVF baby reunions in Norfolk, Virginia, at the clinic where she was born.

“For a while it was just the first, you know, handful of IVF babies,” she says. “I think the last one we had was when I was maybe 10 or 11. And I just remember holding babies 1000 and 1001 that were twins from our specific clinic. And at that point, the reunions had to stop because there was too many of us.”

And by 2021, 86, 146 infants born, or 2.3% of all infants born in the U.S., were conceived through the use of assisted reproductive technology, which includes procedures like IVF, according to the Department of Health and Human Services.

Carr attended President Joe Biden’s state of the union address in March 2024 following the Alabama Supreme Court ruling, which she says was “really, really tough.”

“I read the ruling and immediately was just devastated and heartbroken, not just for how it made me feel personally, which was kind of like a personal attack, but also for all of those people who wanted to be able to access this treatment,” she says.

“IVF is currently the single most effective treatment for infertility, and it has a lot of implications outside of infertility,” she continues. “If you’re a same sex couple looking to build a family, or you’re going through cancer treatments and you want to preserve your fertility, or if you want to have genetic testing to screen out for really terrible diseases in your family history. Things like that.”

Carr, a mother of a 13-year-old son, says she would love to see IVF protected nationally, greater insurance coverage and greater care coverage and access in the U.S. in her lifetime.

“The thing about infertility in particular is that it doesn’t care if you’re a Democrat or Republican,” she says. “It does not discriminate. So, there are people clearly on both sides of the aisle, with one in six people impacted by infertility, that probably need to access IVF.”

“I’m cautiously optimistic that we’ll we’ll get it done,” she adds.

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In a new study, researchers found that most cancer drugs granted accelerated approval do not demonstrate such benefits within five years.

“Five years after the initial accelerated approval, you should have a definitive answer,” said Dr. Ezekiel Emanuel, a cancer specialist and bioethicist at the University of Pennsylvania who was not involved in the research. “Thousands of people are getting those drugs. That seems a mistake if we don’t know whether they work or not.”

The program was created in 1992 to speed access to HIV drugs. Today, 85% of accelerated approvals go to cancer drugs.

It allows the FDA to grant early approval to drugs that show promising initial results for treating debilitating or fatal diseases. In exchange, drug companies are expected to do rigorous testing and produce better evidence before gaining full approval.

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Patients get access to drugs earlier, but the tradeoff means some of the medications don’t pan out. It’s up to the FDA or the drugmaker to withdraw disappointing drugs, and sometimes the FDA has decided that less definitive evidence is good enough for a full approval.

The new study found that between 2013 and 2017, there were 46 cancer drugs granted accelerated approval. Of those, 63% were converted to regular approval even though only 43% demonstrated a clinical benefit in confirmatory trials.

The research was published in the Journal of the American Medical Association and discussed at the American Association for Cancer Research annual meeting in San Diego on Sunday.

It’s unclear how much cancer patients understand about drugs with accelerated approval, said study co-author Dr. Edward Cliff of Harvard Medical School.

“We raise the question: Is that uncertainty being conveyed to patients?” Cliff said.

Drugs that got accelerated approval may be the only option for patients with rare or advanced cancers, said Dr. Jennifer Litton of MD Anderson Cancer Center in Houston, who was not involved in the study.

It’s important for doctors to carefully explain the evidence, Litton said.

“It might be shrinking of tumor. It might be how long the tumor stays stable,” Litton said. “You can provide the data you have, but you shouldn’t overpromise.”

Congress recently updated the program, giving the FDA more authority and streamlining the process for withdrawing drugs when companies don’t meet their commitments.

The changes allow the agency “to withdraw approval for a drug approved under accelerated approval, when appropriate, more quickly,” FDA spokesperson Cherie Duvall-Jones wrote in an email. The FDA can now require that a confirmatory trial be underway when it grants preliminary approval, which speeds up the process of verifying whether a drug works, she said.

At the grocery store, you’ll find an endless array of oils from plants, seeds and other sources. It may leave you wondering: which type of cooking oil is the healthiest? Does it matter if it comes in a big plastic jug or a fancy glass bottle?

Where the oil comes from and how it’s processed can impact its nutrition content and flavor. In short, not all oil is equal. We spoke to dietitians about what to look for when choosing a cooking oil, which oils are healthiest and which oils to limit or avoid.

Is cooking with oil healthy?

“Cooking oil can definitely be part of a healthy diet,” says Natalie Rizzo, registered dietitian and nutrition editor for TODAY.com. Oils can provide essential fatty acids and other nutrients that promote overall health — not to mention, they make food taste a lot better.

Oils are basically pure fat, but fats are an important macronutrient that plays many roles in the body, from providing us with energy to supporting cell function, TODAY.com previously reported.

The key is to consume fewer “bad” fats (trans and saturated) and replace these with more “good” or healthy fats (polyunsaturated and monounsaturated), per the American Heart Association.

It’s important to note that consuming any kind of fat will add additional calories to your intake, Beth Czerwony, registered dietitian with the Cleveland Clinic’s Center for Human Nutrition, tells TODAY.com. “That needs to be considered when evaluating your diet overall,” Czerwony adds.

Moderation is also key. “The serving size for oil is small — one tablespoon — and having more than that can drastically increase your calorie and fat intake above the recommended amount,” says Rizzo. All fat provides 9 calories per gram.

The World Health Organization recommends all adults limit their total fat intake to 30% of their caloric intake or less. If you’re unsure about how many grams of fat you should be eating per day to meet your needs and goals, talk to a nutritionist or your healthcare provider.

Choosing healthier oils

When choosing a cooking oil, it’s important to read the nutrition labels and consider several factors.

Saturated fat

“Some cooking oils may have negative health effects if used in excess, these include those high in saturated fats,” says Czerwony. Saturated fat can raise bad cholesterol or LDL, which can clog the arteries, and consuming high amounts over time increases the risk of heart disease and stroke, per the AHA.

“The American Heart Association recommends choosing oils with less than four grams of saturated fats per one tablespoon (or serving),” says Czerwony.

Fortunately, many cooking oils also contain unsaturated fats, Rizzo adds. Oils rich in monounsaturated and polyunsaturated fats provide the body with essential nutrients, including vitamins and antioxidants.

Healthy fats can boost HDL, or good cholesterol, lower LDL, and stabilize blood glucose levels, TODAY.com previously reported. Unsaturated fats are also beneficial for heart and brain health, says Rizzo.

Oils high in unsaturated fats are liquid at room temperature, whereas those high in saturated fats are solid. “A good way to know if it’s saturated fat is to remember, solid at room temperature equals solid in your arteries,” says Czerwony.

Nontropical plant source

Where the oil comes from can also affect its nutrition content. “There’s oils from fruits, such as olive oil and avocado oil. There are also oils that come from seeds, like canola oil, sunflower seed oil and grapeseed oil. Lastly, there are nut oils, like walnut or peanut oil,” says Rizzo.

The experts recommend opting for cooking oils from nontropical fruits, vegetables, nuts or seeds, as these are healthier choices.

Oils from tropical plants — primarily coconut, palm and palm kernel oil — are much higher in saturated fat and remain solid at room temperature, says Czerwony.

Other types of solid fats used in cooking include animal fats — such as butter, lard, or tallow — which contain large amounts of saturated fat and have been shown to raise bad cholesterol, per the AHA.

Trans fats are formed through a process which uses hydrogen to turn liquid vegetable oil into a solid fat, such as margarine and shortening, per the National Institutes of Health. These should be avoided due to the health risks.

Refined vs. unrefined

When choosing a cooking oil, it’s important to consider how it was processed. Many plant oils are refined to remove particles and make them more heat- and shelf-stable, Czerwony notes.

Refined oils are often cheaper and last longer. They may have a very neutral flavor and withstand higher cooking temperatures, which makes them a practical option in the kitchen.

However, the refining process also removes a number of benefits from the oil, the experts note. “Look for unrefined oils if possible, which will still have more nutrients and antioxidants that are often lost in the refining process,” says Czerwony.

Unrefined oils may appear cloudier or contain sediment, but have a more robust or complex flavor. They tend to be more expensive and have a shorter shelf life, says Czerwony, but the added health and gastronomic benefits are worth it.

Bottom line: When choosing between cooking oils at the grocery store, the experts recommend picking oils that are:

• Low in saturated fat (fewer than four grams per tablespoon)
• Nontropical
• Unrefined

Which oil is best for heating?

Another factor to consider is the cooking method and the “smoke point” of the oil, says Czerwony.

All oils have a smoke point, or a temperature at which the oil starts to degrade and burn, per the U.S. Department of Agriculture. It usually ranges from 325 degrees to 450 degrees Fahrenheit.

“Heating oil breaks down the composition of the oil, which can change the flavor and nutrition,” says Rizzo. Oil can oxidize when it’s exposed to too much heat (or light). “The antioxidants and fat levels in the oil determine how quickly it will oxidize,” Rizzo adds.

Heating oil beyond its smoke point can destroy nutrients and produce free radicals, which damage cells, Czerwony explains. It also causes the oil to taste rancid, which can ruin a dish.

Certain oils are better to use when cooking with high heat — such as searing or frying. These can withstand high temperatures without burning, which should be avoided, says Czerwony. Oils with a high smoke point include avocado, canola, peanut and soybean oils.

Other oils are more suited to medium heat cooking methods, such as baking or sautéing, including olive, grapeseed and vegetable oils.

Oils with a low smoke point should not be heated. “These are (best) for salad dressings or as a flavor enhancement to finish a dish,” says Czerwony. These include walnut, flaxseed and wheat germ oils.

Always make sure to read the label, which often indicates which purposes or cooking methods are best.

What is the healthiest cooking oil?

Olive oil

Olive oil is the top pick among the experts due to its variety of well-researched health benefits. It’s also versatile and can be used to cook or enhance many hot and cold dishes.

Olive oil is packed with healthy fats, including monounsaturated fatty acids — it has the highest amount of any plant oil, per the AHA — which can help lower LDL and blood pressure.

It’s also rich in plant-compounds called polyphenols, vitamins and antioxidants, which have been shown to decrease inflammation and improve heart health, says Czerwony. “Including olive oil in the diet has been linked to reductions in heart disease, diabetes and other chronic diseases,” Rizzo adds.

The experts recommend opting for “extra virgin olive oil” or EVOO, as this is the least processed and typically cold-pressed which retains more nutrients and flavor.

It withstand temperatures up to 410 degrees Fahrenheit, per the USDA, which makes it a great option to bake, sauté, roast and more. Extra virgin olive oil also has the lowest oxidation rate of any oil, per the Cleveland Clinic, which means it’s more stable and less prone to emitting free radicals when heating.

One tablespoon or serving of olive oil contains about 119 calories and 13.5 grams of fat, according to the USDA.

Other healthy cooking oils

There are a number of other nontropical plant oils which provide good fats, vitamins and antioxidants, making them a healthy choice in the kitchen. When choosing an oil, it’s important to consider the flavor and smoke point, as well as any food allergies.

• Avocado
• Canola
• Corn
• Peanut
• Safflower
• Soybean
• Grapeseed
• Sunflower

“Vegetable oil” is typically made from one or a blend of these oils.

What is the least healthy cooking oil?

The least healthy cooking oil is coconut oil, the experts note. “Basically every single oil, except for coconut oil, is a good source of unsaturated fats and is a healthy option for cooking,” says Rizzo.

Coconut oil is 80-90% saturated fat, says Rizzo, compared to other oils which are typically 10–20% saturated fat. “The AHA discourages using coconut oil since the saturated fat can raise LDL cholesterol,” says Rizzo.

“Coconut oil has not had any large-scale research to support any health benefits and it far exceeds four grams saturated fats per tablespoon, making it higher in fat than butter,” says Czerwony.

If you can’t avoid coconut oil, only use it in very small amounts for cooking, says Rizzo. Palm oils are also high in saturated fats and should be avoided, says Czerwony.

Tips for using storing and cooking with oil

Common habits and mistakes in the kitchen can compromise an oil’s freshness, nutrition, and taste. It’s important to store and use cooking oil properly, says Czerwony.

• Choose oil in dark, opaque bottles which protect it from light
• Store oil in a dark, cool place to avoid oxidation or overheating
• Use cooking oil within several months of opening
• Do not use expired cooking oil
• Discard oil that smells rancid
• Do not use oil after it smokes or catches fire
• Do not reuse cooking oil
• Do not refrigerate cooking oils

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The test, called AvertD, was approved by the FDA in December. It detects a handful of genetic markers that the manufacturer, California-based SOLVD Health, claims are associated with opioid use disorder. It’s meant to be used before a person is prescribed an opioid for the first time; for example, ahead of a surgery that a doctor may prescribe a short course of opioids for recovery.  

It’s a promising test, in theory: An opioid prescription, even short-term, can be a path to addiction for some people.

The opioid crisis in the United States has been responsible for almost 645,000 deaths over the last two decades. In 2022, about 6.1 million people in the U.S. were reported to have an opioid use disorder, according to the Substance Abuse and Mental Health Services Administration. 

The agency’s clearance of AvertD, however, went against the advice of its own independent advisory committee, which overwhelmingly voted against approval in 2022 because of concerns that the test may fail to identify people at risk for opioid use disorder, potentially leading to overprescribing.

In a letter addressed to FDA Commissioner Robert Califf dated Thursday, a group of doctors and researchers called on the agency to revoke its approval, saying the test doesn’t predict opioid use disorder “any better than chance.”

“This test will make the opioid crisis worse,” said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University in Massachusetts and one of the those who signed the letter. “It will contribute to overprescribing, it will contribute to an increased incidence of opioid use disorder. In other words, more people becoming newly addicted to opioids.”

The risks of getting it wrong

The authors of the letter take particular issue with SOLVD Health’s claim that its test can accurately predict a person’s risk for opioid addiction using 15 genetic markers.

Getting it wrong has consequences: A test that fails to identify a person at risk may give both the patient and the doctor a false sense of security about opioid use, the authors wrote. On the other hand, mislabeling a patient as at risk could lead a doctor to refrain from prescribing opioids that the patient needs, while also burdening them with a highly stigmatized medical condition. 

The FDA and SOLVD Health did not immediately respond to requests for comment.

In the FDA’s approval statement in December, the agency said it cleared the test because the opioid crisis calls for “innovative measures to prevent, diagnose and treat opioid use disorder,” adding that it worked with SOLVD Health to address the advisory committee’s concerns.

Many in the scientific community, however, are deeply skeptical that a person’s risk of opioid use disorder can be predicted based on only a handful of genetic markers, said Dr. Katherine Keyes, a professor of epidemiology at the Columbia University Mailman School of Public Health in New York. 

Addiction is a “complex trait,” she said, and involves a number of other factors besides genetics, including socioeconomic status and a person’s exposure to a substance.

“We know the risk of OUD increases with the dose and duration of an opioid prescription,” Keyes said, using an acronym for opioid use disorders. “Receiving an opioid prescription remains one of the strongest risk factors for the development of opioid use disorder.”

“You’re not going to find a genetics professor in the United States or anywhere that would say using these 15 genetic markers will tell you anything,” Kolodny said.

Dr. Adam Gordon, a professor of medicine and psychiatry at the University of Utah School of Medicine, voted against AvertD’s approval on the FDA’s advisory panel in 2022. He said that even the agency has acknowledged the risk of using such a test.

In briefing documents published ahead of the advisory committee meeting, FDA staff wrote that genetic risk “may not be the biggest factor” for opioid use disorder. 

And in a release for AvertD’s approval, the FDA said the main risk associated with the test is false positives and false negatives.

In its application for approval, SOLVD Health gauged how effective its test was based on how well it could weed out false negatives and false positives, using measures known as sensitivity and specificity.

A highly sensitive test accurately identifies people with the condition, minimizing false negatives, while a highly specific test accurately rules out people without the condition, minimizing false positives, said Dr. Andrew Saxon, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.

“If your specificity were 75%, it would mean a quarter of the people who you identify in the test as possibly having this disorder did not have this disorder,” he said.

SOLVD Health said in its application that AvertD had demonstrated a sensitivity of about 82% and a specificity of about 79%. 

Those numbers suggest that roughly 1 in 5 results would be false negatives and roughly 1 in 5 would be false positives.

“I think the product has the potential to do harm,” Gordon said. 

As part of AvertD’s approval, SOLVD Health is required to provide training to health care workers to ensure that the test is being appropriately used. The company will also need to run a large-scale study further assessing the test’s effectiveness.

The FDA has a history of approving products that its advisory committees say lack sufficient evidence on their safety or effectiveness.

In 2021, for example, the agency approved Biogen’s Alzheimer’s drug Aduhelm despite its advisory committee rejecting the drug, saying that there wasn’t enough evidence that it worked.

The company took the drug off the market earlier this year.

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CVS Health on Thursday said its drug plans will cover the first over-the-counter birth control pill in the U.S. at no cost for many health plan sponsors, a decision that could open the door for more people to prevent unintended pregnancies without a prescription. 

The company’s pharmacy benefit manager, CVS Caremark, said the pill will be added to its preventive services oral contraceptives list and will be covered at zero cost for many sponsors. The drug, known as Opill from Perrigo, was available at pharmacies starting April 1, according to a pharmacy update from CVS Caremark dated last week and viewed by CNBC.

Pharmacy benefit managers, or PBMs, maintain lists of drugs covered by health insurance plans and negotiate drug discounts with manufacturers. At most stores, Opill has a retail price of $19.99 for a one-month supply and $49.99 for a three-month supply. 

The Food and Drug Administration approved Perrigo’s medication in July. It marks the first time that many U.S. residents are able to buy birth control pills over the counter, the same way they would purchase common pills like Tylenol or Advil. 

The drug could significantly expand availability of contraception, especially for younger women and those in rural and underserved communities who often have trouble getting access to birth control methods. 

Medical organizations have estimated that 45% of the 6 million annual pregnancies in the U.S. are unintended.

The pill’s entrance into the market is a win for the Biden administration, which has tried to shore up reproductive rights as abortion restrictions rise in many states. 

The Supreme Court’s decision to overturn the landmark Roe v. Wade ruling more than a year ago, which ended 50 years of federal abortion rights, has led to shrinking availability of the procedure nationwide and renewed calls for expanded access to birth control.

Amylyx Pharmaceuticals announced it will voluntarily halt sales and marketing of the drug in the U.S. and Canada, where new patients will no longer be able to get a prescription.

“While this is a difficult moment for the ALS community, we reached this path forward in partnership with the stakeholders who will be impacted and in line with our steadfast commitment to people living with ALS,” company co-founders said in a statement. Patients already taking the therapy who wish to continue will be able to enroll in a program to receive it for free.

The Food and Drug Administration approved the much-debated drug, Relyvrio, in September 2022, following a years-long advocacy campaign by patients with amyotrophic lateral sclerosis, or ALS.

The drug’s failure is a bitter disappointment for patients and advocates, who have pressed the FDA and other federal agencies to fund and approve more experimental therapies for the fatal muscle-wasting disease.

Relyvrio’s withdrawal leaves just three ALS medicines available to U.S. patients, only one of which has been shown to extend survival by several months.

Cambridge, Massachusetts-based Amylyx also said Thursday it will lay off 70% of its more than 350 employees as part of a major restructuring effort. Company executives said they plan to continue studying Relyvrio and another experimental drug for several rare diseases, including Wolfram syndrome, which causes childhood diabetes and blindness.

Company shares climbed more than 7.5% in trading Thursday morning.

Amylyx said last month it was considering pulling its drug after a clinical trial in 600 patients failed to show any improvements in survival or other health measures, such as muscle strength or walking ability.

The company’s voluntary action resolves what could have been a major dilemma for the FDA. The agency’s regulators would not have had a clear path to quickly force the drug from the market if the company had refused to remove it. That’s because the FDA granted the drug full approval, despite the preliminary nature of the company’s data on effectiveness.

The 2022 approval was mainly based on results from one small, mid-stage study that was criticized by some of the agency’s own internal scientists. Normally the agency requires two large, late-stage studies that show a clear benefit before granting approval. But at the time FDA officials explained that “regulatory flexibility” was appropriate when reviewing Relyvrio, “given the serious and life-threatening nature of ALS and the substantial unmet need.”

The medication is part of a string of drugs for deadly, degenerative diseases that have won FDA approval in recent years despite questionable evidence they work.

ALS gradually destroys the nerve cells and connections needed to walk, talk, speak and breathe. Most patients die within three to five years of a diagnosis.

Relyvrio is a powder that combines two older drugs: a prescription medication for liver disorders and a dietary supplement associated with traditional Chinese medicine.

Amylyx faced criticism for pricing the drug at $158,000 for a year’s supply. Sales were disappointing, with some patients discontinuing the medicine after only a few months.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

In all, five women who lived in different parts of southwest Michigan suddenly sought help for serious eye problems within weeks of each other.

The medical mystery led to a startling diagnosis: All of the patients had ocular syphilis, a complication of the sexually transmitted disease.

The cluster of cases shared a common link. It turned out the five women had sex with the same man who had syphilis, according to a case report published by the Centers for Disease Control and Prevention in November 2023. His illness was mostly asymptomatic and never affected his eyes.

Few people know syphilis can endanger vision, doctors say.

“Patients are very surprised, and most of the lay public doesn’t think of syphilis involving the eye,” Dr. Rahul Khurana, a spokesperson for the American Academy of Ophthalmology, tells TODAY.com.

“Untreated syphilis in the eye is devastating because it can lead to blindness.”

‘Syphilis crisis’

It’s especially concerning as syphilis cases surge in the U.S.

More than 207,000 Americans were diagnosed with the disease in 2022, an 80% increase since 2018 and the highest levels since the 1950s, the CDC reported in January 2024.

Cases were up in most every region and demographic group, including older people.

The U.S. Department of Health and Human Services called it a “syphilis crisis” and an “epidemic.”

Possible reasons why it’s happening include a rise in substance use, with alcohol and marijuana linked to more risky sexual behavior, Dr. Akshay Syal, a medical fellow with the NBC News Health and Medical Unit, told NBC News Now.

There’s also been a decrease in condom use and less funding for clinics where people can get tested for STDs, he added.

As the crisis unfolds, doctors are seeing more people in the U.S. hospitalized for syphilitic uveitis, or inflammation inside the eye and the most common ocular manifestation of syphilis, according to an investigation published in JAMA Ophthalmology in November 2023.

What causes ocular syphilis?

Syphilis is a sexually transmitted disease caused by a bacterium that invades blood vessels and could involve the central nervous system — when that happens, it can go into the brain and the eye, Khurana says.

The illness can lie hidden in the body only to cause symptoms later in time, so it’s often not caught early and people don’t realize that they have it, he adds. Some of his patients had no idea they were infected until they sought help for eye problems.

“We often call syphilis the great imitator because it looks like many other things,” says Khurana, who is ophthalmologist at Northern California Retina Vitreous Associates.

“Because it’s non-specific, it’s often missed by many ophthalmologists, and many people don’t even think about it.”

Besides causing blindness, untreated syphilis can seriously damage the heart and brain, and cause deafness and paralysis, the CDC warns.

What are the symptoms of ocular syphilis?

When syphilis affects the eyes, it usually causes inflammation inside them known as uveitis, Khurana says.

Eyes may be red, light sensitive or painful, he notes.

“Whenever I have a patient with uveitis, I always rule out everybody for syphilis just because it can present in so many different ways that you don’t want to miss it,” Khurana notes.

Syphilis accounts for 1% to 5% of cases of eye inflammation, according to the American Academy of Ophthalmology notes.

Other possible symptoms of ocular syphilis include floaters, blurry vision or even blindness, the CDC warns.

A blood test can confirm if a patient has syphilis.

What is the treatment?

If there’s a positive test, it’s important for the patient to see an infectious disease doctor because when syphilis involves the eyes, it’s also potentially involved in the brain, Khurana says.

Patients are treated with an intravenous antibiotic for 10 to 14 days and usually respond well, he notes. They may also get anti-inflammatory medicine to take care of the eye inflammation.

“If these things are caught early and treated early, patients could do very well,” Khurana says. “The challenge with syphilis is that often (doctors) don’t think about it, and so the diagnosis is often delayed.”

He urges eye doctors to have a “high index of suspicion” and rule out syphilis when patients show up with eye inflammation.

Treatment may not undo any damage caused by the infection, the CDC warns.

Using condoms every time you have sex can reduce the risk of getting syphilis, the agency notes.

Always get checked for any vision problems to rule out eye syphilis or other sexually transmitted diseases. STDs such as herpes and gonorrhea can also harm the eyes, according to the American Academy of Ophthalmology.

“With the incidence of STDs and syphilis on the rise in the community, I think everyone should be aware of it,” Khurana says.

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Led by its chairman, Sen. Gary Peters, D.-Mich., the inquiry by the Homeland Security and Governmental Affairs Committee centers on three of the nation’s largest private-equity firms: Apollo Global Management, the Blackstone Group and KKR. According to the information requests, Peters’ staff conducted interviews with over 40 emergency department physicians who expressed “significant concerns” about patient safety and care resulting from the aggressive practices of private-equity firms in the arena. Those practices include improper billing, retaliation and anti-competitive activities, the committee’s letters to the companies said.

Recipients of the letters, which were sent Monday, were asked to provide documents and information by April 17, and to arrange a meeting with the committee no later than May 3.

NBC News recently estimated that 40% of U.S. hospital emergency departments were overseen, staffed or managed by companies owned by private-equity firms.

The Homeland Security Committee inquiry is the second Senate investigation focused on private equity’s impact on patient care. In December, the Budget Committee launched a bipartisan investigation into two hospital systems associated with private-equity firms, seeking to assess the profits they have generated in their deals and whether those transactions harmed patients and clinicians. Sens. Sheldon Whitehouse, D.-R.I., who chairs the committee, and Chuck Grassley of Iowa, the ranking Republican, are leading that examination.

The new letters from the Homeland Security Committee requesting information about emergency department operations also went to four companies backed by the private-equity firms. Three are hospital staffing companies: U.S. Acute Care Solutions, which is financed by Apollo; Envision Healthcare, formerly owned by KKR; and TeamHealth, a Blackstone company. The other recipient is LifePoint Health, owned by Apollo, which operates 62 acute care hospitals in 16 states and runs the largest chain of rural hospitals in the U.S. Apollo and LifePoint Health are also subjects of the Senate Budget Committee investigation.

In recent years, private-equity firms have invested $1 trillion and become significant players in many sectors of the health care industry, including hospitals, nursing homes, physician practices, mental health facilities and emergency department staffing companies. To finance their health care takeovers, private-equity owners typically burden the companies they buy with debt, then slash company costs to increase earnings and appeal to new buyers in a few years.

These cost-saving practices are central to the new Senate inquiry, Peters said in a statement. “I am concerned that our nation’s largest emergency medicine staffing companies may be engaging in cost-saving measures at the expense of patient safety and care, which could put our nation’s emergency preparedness at risk,” Peters’ statement said. “I am pressing these companies and their private equity owners for needed transparency so that we better understand how their business practices could be affecting patient safety, quality care, and physicians’ abilities to exercise independent judgment in providing patient care.”

In a statement, a spokesperson for Apollo said, “We continue to welcome all discussions with the senators regarding our funds’ investing track record in the healthcare space.” A spokesperson for Envision said, “Envision intends to work transparently with Senator Peters on his request. Our clinicians care for patients and communities in their greatest time of need. Our number one priority is always the well-being of our clinicians and the patients they serve.” A spokesperson for Lifepoint said the company “looks forward to responding to Chairman Peters’ inquiry received today and to furthering any conversations with Senators who have an interest in our operations and commitment to our communities.”

KKR and Blackstone declined to comment.

As interest rates have risen recently, the costs associated with some of these companies’ debt loads have become onerous, creating financial difficulties. Last year, for example, Envision Healthcare, the staffing company formerly owned by KKR, filed for bankruptcy. It continued operating while in bankruptcy and emerged having restructured. Another emergency department staffing company collapsed last year — American Physician Partners — leaving hospitals it had served scrambling for replacement staffing.

Academic studies show that private-equity firms’ involvement in health care is associated with significant cost increases for patients and payers, such as Medicare. A lower quality of care has also been associated with the firms’ investments in health care, including 10% higher mortality rates at nursing homes owned by private equity. A study last year showed patients at private equity-owned hospitals fell more often and contracted more infections.

A TeamHealth spokesman said the company is reviewing the letter from Peters. “The top priority for TeamHealth and our clinicians is always delivering high-quality, safe patient care,” he added in a statement. “We look forward to engaging with the Committee and demonstrating our uncompromised commitment to our clinicians and communities.”

Private-equity firms’ health care deals are also under the microscope at the Federal Trade Commission, which overseas corporate mergers for potential anti-competitive activities. Last fall, the FTC sued U.S. Anesthesia Partners Inc., one of the country’s top anesthesia staffing companies, and its private-equity backer, Welsh, Carson, Anderson & Stowe, accusing the entities of scheming for over a decade to acquire anesthesia practices in Texas, monopolize the market, drive up prices for patients and generate profits. Both companies are fighting the suit, contending it is “misguided” and “meritless.”

Mitchell Li is one of the emergency physicians interviewed by investigators at the Homeland Security Committee. Founder of Take Medicine Back, an organization pushing to take the profession of medicine back from corporate control, Li said in an interview, “The emergency department is the canary in the coal mine for the whole U.S. health care system. We are the first to see the breaking point and we are beyond that. Private equity and the corporate practice of medicine puts our nations’ ability to respond to disaster at risk.”

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How much of a price jump isn’t yet known. The premium increase would depend on how many millions qualify for the popular medication, which is priced at around $1,300 a month. 

It’s possible premiums could go up as soon as 2025, although 2026 or beyond is more likely, according to at least one health policy expert.

“I worry greatly, both in terms of higher premiums and also Medicare funds over the next decade,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “The drug needs to be taken lifelong to be effective, so we’re looking at potentially enormous lifelong costs.”

The drug will be covered under Medicare Part D, which pays for prescription drugs people take at home, according to the Centers for Medicare and Medicaid Services. Last year, more than 50 million of Medicare’s enrollees used Part D plans, according to KFF, a nonpartisan group that studies health policy issues. 

This year, people on Medicare Part D pay an average monthly premium of $55.50, according to the CMS. After they meet a so-called coverage gap, patients are on the hook for 25% copays until they spend a certain amount out of pocket, which varies by plan. Part D plans are provided by private insurance companies that have contracts with the U.S. government.

A handful of Part D providers, including CVS Health and Kaiser Permanente, have already said they would start covering Wegovy for patients with heart disease risk. Every major insurance company has been asked for comment.

Under the CMS’ guidelines, Wegovy can be prescribed only to people with heart disease who are either overweight or obese. Medicare won’t pay for Wegovy if it’s being used only for weight loss. 

It’s not yet clear how many on Medicare meet those criteria. Juliette Cubanski, deputy director of the program on Medicare policy at KFF, estimated that it is most likely “several million people.”

“If costs go up, then the contribution from the federal government goes up, and generally speaking, beneficiary premiums also go up,” she said.

It’s unlikely that a rise in monthly premiums linked to Wegovy will happen within the next year, said Jeffrey Davis, the health policy director at McDermott and Consulting, a group that provides data analytics and policy advice to the health care industry. 

That’s because, he said, private insurance companies that provide Part D coverage have already begun locking in payment rates with Medicare for the 2025 enrollment year.

On the other hand, insurers could still jack up premiums next year if early projections of Wegovy’s costs come in higher than expected, he said. 

An analysis published by KFF last month found that gross Medicare spending on the diabetes drug Ozempic, which shares the same active ingredient as Wegovy, increased from $2.6 billion in 2021 to $4.6 billion in 2022, making it the sixth top-selling drug in Medicare Part D that year. Medicare began covering Ozempic in 2018. 

However, Davis added, any kind of premium increase caused by Wegovy is much more likely to happen as early as the 2026 enrollment year. 

“This drug is expensive,” Davis said. “If millions of people are covered, it could increase premiums going forward.”

Cubanski said even a few dollars in higher premiums can be a big deal for people on Medicare who often are retired and have limited incomes.

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Barriers to coverage

It’s important to note that Medicare is allowing insurers that provide Part D coverage to establish rules before they cover Wegovy, a practice that might restrict access in the near term and could keep premiums low, said Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund. 

Those rules include step therapy, which requires patients to try lower-cost medications before they are allowed to try medications that cost more, Gretchen said.

Some commercial insurers, for example, might start patients off with an older weight-loss medication before they’re allowed to get prescribed a GLP-1 drug.

Insurers can also require Medicare Part D patients to get prior authorization from their insurance companies before they can get the medication.

Dr. Amit Khera, a fellow at the American Heart Association, said that prior authorization is typical for other expensive heart medications and that it’s often a burdensome process for both providers and patients who have to regularly submit medical records and tests showing they meet the requirements for drugs.

“I think the intent is sort of to ensure the right patient gets the right medicine, but practically, it ends up just being an incredibly cumbersome process that, in some ways, can restrict access,” Khera said.

Limiting costs

While insurance companies get a bad reputation for limiting access to patients, Novo Nordisk may also need to share blame for the high cost, Gostin said. 

He isn’t alone in that view: Sen. Bernie Sanders, I-Vt., the chair of the Health, Education, Labor and Pensions Committee, last month called on the drugmaker to lower the cost of the drug.

He cited a study by Yale researchers that found that Ozempic and Wegovy could cost less than $5 a month to make, even though Novo Nordisk charges $1,000 a month in the U.S. for semaglutide, the active ingredient in Wegovy. 

“I think Bernie Sanders is right to call on them to do that, particularly when it’s selling to Medicare enrollees,” Gostin said. 

Even if Novo Nordisk doesn’t lower the prices, semaglutide could be up for Medicare drug pricing negotiations under the Inflation Reduction Act as early as next year, Cubanski said. 

The negotiated prices wouldn’t go into effect until 2027.

Davis also said it’s possible insurers providing Part D coverage could negotiate better rebates — discounts drug companies give insurers in exchange for coverage — that could lower the costs for a period of time.

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If he turned his head to look out the window, Dr. John Nkengasong said, he knew what he would see: another desperate family carrying a dying loved one — a man or woman already lapsing into a coma, a stick-thin child — and hoping to find help.

It was before the Bush administration started the U.S. President’s Emergency Relief Plan for AIDS Relief, known as PEPFAR, in 2004. There was almost no affordable effective treatment anywhere between South Africa and the Sahara, no rapid HIV tests or high-quality government labs, and few beds for AIDS patients.

Nkengasong has spent decades working in Africa on HIV and AIDS, a career intertwined with the U.S. program that since its introduction 20 years ago has transformed care in some of the hardest-hit countries and saved an estimated 25 million lives. He spoke to The Associated Press during a battle over funding in Congress that imperils the AIDS program’s future.

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Opponents say the HIV/AIDS funding could be indirectly supporting abortion abroad, although the Biden administration and PEPFAR’s defenders say there is no evidence that it does. After a handful of conservative lawmakers threatened for months to block the funding unless restrictions were attached, a compromise was struck in late March that extends the funding for a year.

But advocates of the program warn that without the full five-year renewal, its future remains in doubt as the political debate over abortion and reproductive rights only becomes more combative.

Before PEPFAR, in most cases, Nkengasong’s infectious disease clinic in Abidjan, in the Ivory Coast, could offer the families no care. In their loved ones’ last hours, the families who came there often were left to crouch outside, in the parking lot.

They would surround “a skeleton of a human being, with a tinge of flesh over their bodies,” Nkengasong recalled. “They held their loved ones, giving them the best comfort they could.”

Soon enough, the sound of wailing would rise through his windows. The cries signaled another death to HIV/AIDS, one of millions in Africa by the mid-2000s.

The scene would be repeated “nearly hour by hour,” Nkengasong said. Sometimes he would get up and close the curtains, blocking out the misery of an epidemic he could not then stem.

Two decades later, Nkengasong says, his trips to the region from his offices in Washington bring joyous meetings with men, women and children whose lives were saved through PEPFAR, credited as the biggest government effort ever against a single disease.

In all, the U.S. program has spent more than $110 billion on HIV care and treatment, local medical systems and social programs aimed at stemming infection. The U.S. says it has saved 25 million lives in sub-Saharan Africa and other vulnerable regions, including those of 5.5 million children.

‘A THRIVING INDUSTRY OF COFFINS’

Nkengasong, who was born in Cameroon and did his graduate studies in Belgium, worked in Africa in the 1990s, when the AIDS epidemic was raging all but unchecked.

It made for a “thriving industry of coffins,” he said. Visiting cities in Uganda, Rwanda, Kenya and elsewhere for his work on infectious diseases, he would travel streets lined by handmade coffins of all sizes.

Beds of infectious-disease clinics were full of “adults lying there looking like babies, because of what HIV had done. That ugly face,” Nkengasong recalled.

With early retroviral medication averaging $10,000 per patient per year, only 50,000 HIV-infected people in sub-Saharan Africa were estimated to be receiving effective treatment in the mid-to-late 1990s. That was out of what the World Health Organization said was 10 million people there living with HIV and AIDS.

THE ‘AHA’ MOMENT

One day in spring 2002, as he was in his lab conducting tests, a large American delegation suddenly arrived at the clinic in Abidjan.

Health Secretary Tommy Thompson and other leading U.S. health officials crowded into the facility, along with representatives of businesses and members of faith-based organizations.

“I remember opening the door and the first person who walked through was Dr. Fauci,” Nkengasong recounted. Anthony Fauci, a leading HIV researcher, was then a top official at the U.S. National Institutes of Health and a leader in Nkengasong’s field of HIV and AIDS work. “And he said, ‘John, good to see you again.’ And I was so excited.”

Unbeknownst to Nkengasong and his colleagues, national security adviser Condoleeza Rice and other officials privately had been making the case to President George W. Bush that the global HIV epidemic was where the U.S. could make a huge difference.

For the Bush administration, the epidemic presented an opportunity to do good at a time when the U.S. was waging war in Afghanistan and later Iraq as well after the Sept. 11, 2001 attacks.

Nine months after the Americans showed up in his lab, “we’re watching news on CNN, it was the State of the Union address,” Nkengason recalled. “And President Bush announced the start of PEPFAR.”

That night, the president pledged an initial $15 billion over the next five years to tackle the AIDS epidemic around the world.

Nkengason called it the “aha moment” for himself and others fighting AIDS in the most vulnerable region of the world.

Two decades later, AIDS deaths globally have fallen nearly 70% from their peak in 2004. Sub-Saharan Africa is still the most vulnerable region and home to two-thirds of the people living with HIV. But the PEPFAR program and others have strengthened health care systems to deal with infectious diseases, made treatment available to millions, and expanded support for the most at-risk populations, including women.

On a trip back to Abidjan, Nkengasong met a healthy 17-year-old girl, one of millions spared from infection at birth thanks to medical treatment that prevented HIV transmission from their infected mothers.

This past summer, he visited a clinic in Namibia where HIV-infected mothers had delivered “super healthy” babies thanks to treatment that saved them from infection.

“I grabbed some of the babies and looked at them,” he said. Holding them, he wondered what would have happened to them without proper care.

“And they just give you that smile,” he said.