Waiting Almost Over For High Court Decision On Health Care Law

The scene outside the U.S. Supreme Court this morning: lights, camera and soon action.Enlarge Scott Hensley/NPR

The scene outside the U.S. Supreme Court this morning: lights, camera and soon action.

Scott Hensley/NPR

The scene outside the U.S. Supreme Court this morning: lights, camera and soon action.

Outside the U.S. Supreme Court early this morning, there were some tired faces, quite a few smiles and the vibe you sometimes feel when a pack of marathoners is nearing the finish line.

Everyone's tired, but there's a sense of anticipation that the long legal slog is almost over.

Three months after historic arguments before the high court over the constitutionality of the administration's sweeping health care law, we're about to find out if it will hold up.

Lately, a lot of us have been gripped by the irresistible urge to handicap how the justices will vote. It's harmless enough, but pretty much fruitless.

At the heart of it all is one legal question: Can the federal government compel uninsured people to buy health coverage?

 

Opponents of the law see the so-called individual mandate as coercive and an illegal intrusion by the federal government into the lives of Americans. Some supporters of the law liken the insurance requirement to the same one for auto coverage.

The high court could strike down the law entirely, chuck the mandate and leave other parts of the law intact, or uphold the whole thing.

Without the mandate, though, it's hard to see how other parts of the law, such as a ban on insurers denying coverage to people with preexisting conditions would work very well.

Insurance works best and costs the least when the everybody is in the pool.

Bettors over at Intrade, an online hangout for prognosticators, put the chances the individual mandate goes down at 73.7 percent early Thursday.

We'll find out who's right in a few hours.

Obesity Stokes Rheumatoid Arthritis With More Than Just Extra Weight

Rheumatoid arthritis is an autoimmune disease that can cause painful inflammation in the fingers and other joints.Enlarge Richard Rudisill/iStockphoto.com

Rheumatoid arthritis is an autoimmune disease that can cause painful inflammation in the fingers and other joints.

Richard Rudisill/iStockphoto.com

Rheumatoid arthritis is an autoimmune disease that can cause painful inflammation in the fingers and other joints.

Rheumatoid arthritis is a disease that causes painful joint inflammation and can be debilitating for many people who suffer from it. New research shows that the female hormone estrogen, along with proteins produced by the body's fat cells, may play an important role in the development of the disease.

A recent study by researchers at the Mayo Clinic found that obese individuals were 25 percent more likely to develop rheumatoid arthritis than people of normal weight. And although it may seem intuitive that excess body weight could cause joint pain, says Eric Matteson, a rheumatologist at the Mayo Clinic who led the study, the link between rheumatoid arthritis and obesity is more than just stress on the joints from being heavy.

"The link, we think, has to do with the activity of the fat cells themselves," says Matteson.

 

Unlike osteoarthritis, a form of arthritis that is caused by wear and tear on the joints, rheumatoid arthritis is an autoimmune disease, says Matteson. It occurs when the body's immune system attacks the lining around joints, and the resulting inflammation leads to the destruction of bone and cartilage. Matteson says it's the fat cells that stoke the fire of inflammation.

"We have recognized in the past several years that fat cells are important mediators of inflammation," Matteson says. "They are immunologically active, and they produce proteins that are inflammatory."

Along with a host of molecules that increase inflammation, fat cells produce the female sex hormone estrogen. What's more, there seems to be a gender bias in inflammatory diseases: A woman's risk of developing one is nearly twice that of a man's, and three out of four people who have rheumatoid of arthritis are women.

But studies on estrogen replacement and oral contraceptives have yielded conflicting results, leading Matteson and others to conclude that estrogen is likely just a small piece of a complicated puzzle.

"There's definitely a hormonal link, although we don't know yet what the exact nature of that link is," says Matteson.

Over the past several decades, obesity rates have risen, and so have the rates of arthritis. Matteson says drugs used to treat rheumatoid arthritis generally don't work very well in obese patients.

But if being obese increases your risk, does losing weight help? Matteson believes it can help a lot: Not only does it help relieve stress on painful and inflamed joints, he says, but losing weight also generally makes the drugs work better.

Gail Bishop, 58, agrees. She has had arthritis since she was 16, and although she is a healthy weight now, she was once 65 pounds heavier. She says losing the weight and watching her diet has had an enormous impact on her arthritis symptoms.

"When I was heavier, that knee gave me quite a bit of trouble," says Bishop. "And now that the weight is off, it's pretty much pain-free. So it makes a dramatic difference."

Bishop says she may not be able to control her arthritis, but she can control what she puts in her mouth â€" and as a result, how she feels. Another way to reduce risk: Don't smoke. Smoking dramatically increases the chances of developing rheumatoid arthritis.

Scientists Find New Wrinkle In How Cholera Got To Haiti

A Haitian protester in Port-au-Prince last year spray-paints a wall, equating the UN mission in Haiti (abbreviated here as MINISTA) with cholera.Enlarge Thony Belizaire/AFP/Getty Images

A Haitian protester in Port-au-Prince last year spray-paints a wall, equating the UN mission in Haiti (abbreviated here as MINISTA) with cholera.

Thony Belizaire/AFP/Getty Images

A Haitian protester in Port-au-Prince last year spray-paints a wall, equating the UN mission in Haiti (abbreviated here as MINISTA) with cholera.

Most researchers currently believe that United Nations peacekeeping soldiers introduced cholera to Haiti in October of 2010.

After all, Haiti hadn't recorded cholera for as long as a century, Nepal had experienced a cholera epidemic in the months preceding the soldiers' arrival, and the Haitian and Nepalese cholera strains were found to be nearly identical.

But it's not that simple, says a research group based at the University of Maryland.

 

These researchers have found two very different cholera strains in some of the first Haitians to be struck by the disease.

One is a so-called 01 serotype with close resemblance to the Nepalese strain, found in about half the patients sampled. The other is a type called non-01/O139 that has never been known to cause an epidemic; it was found in 21 percent of patients. Another 7 percent of patients harbored both types.

What can this mean? It's not clear, but the leader of the team, Rita Colwell, thinks cholera germs have been lurking undetected in the Haitian environment for a long time.

"This suggests that it's very likely that local (Haitian) strains are involved," Colwell told Shots. "Because no one has tested for pathogenic cholera strains in that country before, we have no evidence that it wasn't there already."

I asked Colwell if she thinks one strain was introduced by the Nepalese soldiers and the other was native to Haiti, or at least predated the current epidemic.

"The introduction (from Nepal) can't be ruled out but it can't be proven either," she replied. "I think the evidence is at best circumstantial, and it is not sufficient to account for the entire epidemic."

Colwell, an internationally recognized expert on the interaction of cholera and environmental factors, thinks Haiti's explosive epidemic is most likely explained by the "perfect storm" of three converging factors.

"You have this massive earthquake in January 2010," she says. "The geology of Haiti is limestone. With earthquake effects disrupting the rivers, the rivers become very alkaline." Colwell's studies have shown that the bacterium Vibrio cholera thrives in alkaline waters.

"Then Haiti had one of the hottest summers on record," she continues. That warmed the estuaries where cholera likes to breed in tiny crustaceans, further abetting the bacteria's cause.

"That was followed by a hurricane that skirted Haiti, causing heavy rain and flooding," Colwell points out. "With all the river systems churned up with nutrients and warm water, and proper alkalinity, it would be ideal for the organism to become quite dominant."

No doubt some will be skeptical. With Haiti's climate, geography, proneness to hurricane-related flooding and notorious poor sanitation, some may doubt that cholera epidemics could have been absent, or overlooked, until 20 months ago.

But some scientists think Colwell is onto something.

Dr. David Sack of the Johns Hopkins Bloomberg School of Public Health doesn't buy the hypothesis that Nepalese peacekeepers started the epidemic by contaminating a leaky latrine upstream from the first cholera cases.

He thinks the epidemic exploded too soon after the Nepalese reportedly arrived in Haiti. UN officials tell him that was on October 8, and the first cholera case was recorded on October 12 in a town near the UN camp.

"Cholera's incubation period is at least 24 hours, sometimes two or three days," Sack told Shots. "Just to have a cholera vibrio floating downstream, and considering the dilution factor â€" well, it raises questions in my mind. Not that it wasn't imported. I think it was imported. I just question when it was imported."

Sack thinks we may never know how the South Asian strain of cholera got into Haiti.

As for the non-01/O139 strain, Sack thinks it might have been hiding in Haiti's environment, waiting for Colwell's perfect storm.

In any case, Sack says the Colwell group has focused new attention on the environmental factors behind the epidemic. And both agree that, going forward, controlling cholera in Haiti will take a massive effort to provide clean drinking water plus vaccination against the disease.

"I would be very strongly in favor of a combination of provision of safe water and vaccine," Colwell says. "That could be very, very effective."

A pilot project this spring has vaccinated close to 100,000 Haitians in Port-au-Prince and the river delta where cholera first appeared in large numbers. But it will take millions of doses, renewed every two to three years, to protect most Haitians at risk. Sack wonders where that much vaccine will come from; it's multiples of the world's current supply.

So far, Haiti has counted 557,397 cases of cholera since the epidemic's beginning, and 7,278 deaths. The current rainy season that began in March, which fosters cholera outbreaks, has added nearly 30,000 cases and 250 deaths to that total.

As More Americans Live Through Cancer, Survivors' Ranks Grow

An American Cancer Society Relay for Life event at the University of Texas-Dallas in 2006. The events are meant to "celebrate the lives of people who have battled cancer, remember loved ones lost, and fight back against the disease," according to the organization.Enlarge Josh Berglund/via Wikimedia Commons

An American Cancer Society Relay for Life event at the University of Texas-Dallas in 2006. The events are meant to "celebrate the lives of people who have battled cancer, remember loved ones lost, and fight back against the disease," according to the organization.

Josh Berglund/via Wikimedia Commons

An American Cancer Society Relay for Life event at the University of Texas-Dallas in 2006. The events are meant to "celebrate the lives of people who have battled cancer, remember loved ones lost, and fight back against the disease," according to the organization.

A cancer diagnosis is no longer a death sentence for many people who get one.

The ranks of American cancer survivors are growing, and will increase from 13.7 million in January 2012 to nearly 18 million in January 2022, according to a report from the American Cancer Society and the National Cancer Institute.

Though an aging and growing population helps explain why more people are surviving cancer, the study says that improvements in treatment and more people getting screened also play a part. (Not all screening is necessarily a good idea for everyone, though, as we've reported.)

The study was published this week in the journal CA: A Cancer Journal for Clinicians.

 

Elizabeth Ward, a national vice president at the American Cancer Society, said that the results are an estimation based on current trends in cancer survival. "But it's conceivable that if there is a major breakthrough in survival rate for one of these cancers, that in fact the picture in 2022 will look different," she tells Shots.

The study reports that in 2012, male survivors were most likely to have had prostate cancer, colon and rectal cancer, and melanoma; most common among female survivors were breast, uterine, and colon and rectal cancers. The American Cancer Society predicts that nearly all of those will be the most commons cancers of survivors in 2022, too.

"The reasons that some cancers are more common in survivors than they are in newly diagnosed patients is that the common cancers among survivors are typically ones that are fairly common in the population of new diagnosis," Ward said, "but they are also cancers that have a fairly high survival rate."

Ward said that although the study provides important data for the future of surviving cancer, there are still issues that are difficult to represent in charts and percentages. Many survivors struggle to live a normal life after treatment, she said.

"There needs to be more work on understanding more fully both the physical and emotional and social needs of cancer survivors," Ward said, "and physical rehabilitationâ€"exercise interventions, to help regain ability to live daily life after treatment being immobile for treatment for a long period of timeâ€"regaining previous level of physical activity."

Cancer survivors must also be vigilant in the continuation of cancer screenings and preventative health, Ward said. "[This includes] dietary and physical activity recommendations and avoiding the use of tobacco because in some cases, it actually seems to have an influence on cancer prognosis, but it's also very helpful in avoiding other cancers and chronic diseases throughout life," she says.

UnitedHealthcare Pledges To Keep Popular Coverage, Regardless Of Supreme Court

A stethoscope rests on a broken piggy bank.

iStockphoto.com

One of the nation's largest insurers said early Monday it would continue to follow some of the rules in the federal health law that are already in effect, including keeping young adults up to age 26 on their parents' plans and ending lifetime dollar limits, no matter what the Supreme Court decides.

UnitedHealthcare, which covers about 26 million people in plans that could be affected by such regulations, is the first insurer to make public such a promise. The Supreme Court justices are expected to rule sometime this month and could uphold the law, remove parts of it or reject the entire legislation.

 

The insurer said no matter what, it would continue to offer policyholders no-copayment preventive services, such as cancer screenings, and third-party appeals for cases where treatments are denied. United also said it would not cancel policies retroactively, except in cases of fraud.

Those rules score high on public opinion polls, even among people who say they don't like the overall law.

United stopped short of saying it would continue to accept all children, no matter if they had a pre-existing medical condition. The federal law says insurers cannot reject children up to age 19 simply because they have a medical condition.

While the company "recognizes the value of coverage for children" United said "one company acting alone cannot take that step," adding that it is "committed to working with all other participants in the health care system to sustain that coverage."

No mention was made of other rules in the health law that some insurers find onerous, including a requirement that they issue rebates to customers if they fail to spend at least 80 percent of premiums on medical care.

What happens if all or part of the law is rejected is the subject of near-constant speculation in Washington and beyond. Many experts believe that even if the court rejects the law, some things across the industry may not change immediately. For young adults on their parents' policies, for example, insurers would likely need to continue coverage until the policy's contract term expired.

United did not disclose what retaining the provisions would cost.

"These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue," said Stephen J. Hemsley, president and CEO of UnitedHealth Group said in a statement. "These provisions are compatible with our mission and continue our operating practices."

Tim Jost, a consumer advocate and a law professor at Washington and Lee University, said he hoped other insurers follow suit. One thing the United statement demonstrates, he said, is that "the provisions are not bankrupting the industry."

But, while the rules United mentioned tend to be popular in opinion polls, Jost said, other provisions in the law will do more to cover the uninsured. Those include preventing insurers from rejecting adults with pre-existing medical conditions and the government tax credits aimed at helping low and moderate income Americans purchase coverage, both of which begin in 2014.

"I'm glad to hear United is doing this and I hope other insurers follow suit," said Jost. "But that doesn't solve the problem of the uninsured, which is why we need the rest of the health bill."

Very Early Signs of Pregnancy

It may surprise you to know that missing a period is not the first sign of pregnancy and in fact, it comes after quite a few signs and symptoms. By the time you miss a period that indicates pregnancy; there can be at least 5 very early symptoms that you failed to notice. If you are sensitive enough to notice, it may not be difficult to notice these symptoms.

Some very early signs of pregnancy which happen much before the expected mom misses a period are:

  • Breast tenderness â€" Changes in the breast are one of the earliest noticeable symptoms of pregnancy. After conception, a lot of hormonal changes start in the body and within a week or two, the breasts become swollen, tender or sore. You will find them to be sensitive when touched and they also feel fuller and heavier. The areas around the areola can darken too. Bear in mind that tenderness in breasts can also be caused by hormonal changes due to other factors such as change in birth control pills and menstruation.
  • Rise in body temperature â€" When you conceive, your basal body temperature (when temperature is at its lowest, i.e. during rest) starts rising. This happens because of implantation of fertilised eggs. After the release of eggs from the ovary, i.e. ovulation, it is fertilised by a sperm. This takes from 6 to 12 days. The hormonal changes due to these processes cause the basal body temperature to rise by one to one-and-half degree. You will need a special thermometer to measure the rise in basal body temperature. This symptom can show even two days after ovulation.
  • Nausea accompanied with vomiting - Also called “morning sickness,” this very early and discomforting sign of pregnancy generally occurs in women around the 6th week of pregnancy. But it can occur earlier too. Around half of all pregnant women face morning sickness problems â€" but all of them may not have the problem of vomiting. But, it is nearly always accompanied by nausea. Often thought to be caused by increased levels of hormones in the body, there are doctors who feel morning sickness is a sign of health of the baby. It shows that baby is developing normally, and that there is nothing much to worry about the progress of pregnancy.
  • Constipation â€" This is an early pregnancy symptom which is often overlooked. Constipation has been defined as less than 3 bowel movements in a week. But needless to say, one can easily confuse it to be caused by some other reason. As the level of hormones keep on changing due to pregnancy, your digestive system slows including the frequency and time of bowel movements. So, if you are conscious of pregnancy and want to know about as early as possible, look for the signs of constipation along with breast tenderness and rise in basal body temperature. Do not ignore constipation as it may indicate “good news”.
  • Fatigue â€" You do feel tired daily but fatigue is different from the usual tiredness that comes after working the whole day. Fatigue is different from tiredness as the latter is a case of the body having lost its energy which needs to be replenished. Fatigue, on the other hand, is due to cancer, auto-immune disorder and other conditions. One of these is pregnancy. With the rise in level of progesterone, the other bodily functions are affected a lot. Other than progesterone, the very fact that your body now needs to have energy for your baby as well as your own needs puts a big strain on the energy resources. So, watch out for apparently inexplicable fatigue as a very early sign and symptoms of pregnancy.

Image: imagerymajestic / FreeDigitalPhotos.net

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  • What's Different About The Brains Of People With Autism?

    Jeff Hudale, who is autistic, demonstrates a face recognition test at the University of Pittsburgh in 2010. Researchers use eye tracking devices to monitor and record what he is looking at.Enlarge Rebecca Droke/Pittsburgh Post-Gazette

    Jeff Hudale, who is autistic, demonstrates a face recognition test at the University of Pittsburgh in 2010. Researchers use eye tracking devices to monitor and record what he is looking at.

    Rebecca Droke/Pittsburgh Post-Gazette

    Jeff Hudale, who is autistic, demonstrates a face recognition test at the University of Pittsburgh in 2010. Researchers use eye tracking devices to monitor and record what he is looking at.

    Like a lot of people with autism, Jeff Hudale has a brain that's really good at some things.

    "I have an unusual aptitude for numbers, namely math computations," he says.

    Hudale can do triple-digit multiplication in his head. That sort of ability helped him get a degree in engineering at the University of Pittsburgh. But he says his brain struggles with other subjects like literature and philosophy.

    "I like working with things that are rather concrete and structured," he says. "Yeah, I like things with some logic and some rules to it."

    So Hudale, who is 40, does fine at his job at a bank. But he doesn't do so well with social interactions, where logic and rules aren't so obvious.

    "Most people my age are nowadays married," he says. "But me, not only am I totally single, I've never even had a date."

     

    What Hudale has done for the past 25 years is help scientists understand autism â€" by letting them study his brain.

    Hudale's career as a research subject began in 1985. He was 13 and had just been committed to the Western Psychiatric Institute at the University of Pittsburgh, where he was misdiagnosed as a schizophrenic.

    During his stay, a neurologist named Nancy Minshew ran some tests on Hudale and realized that his real problem wasn't schizophrenia; it was autism.

    She and her colleagues also realized that even though Hudale was still a teenager, his intelligence and curiosity about what was going on in his own brain made him a great candidate for research studies.

    So not long after Hudale returned home, Minshew and other researchers began asking him if he'd be willing to take part in some experiments. Hudale says he didn't hesitate.

    "When I first started learning what this is really about I thought â€" if I can get some benefit to help my health out that would be great," he says. "But now I realized this not only helps me, but it can help other people with similar troubles, and I'm all for it."

    So Hudale said yes to just about every scientist who asked him to participate in an autism study.

    That was back in the mid-1980s, when researchers still considered the human brain a sort of black box because there was no way to watch the activity going on inside.

    Marcel Just, a brain scientist at Carnegie University, says researchers everywhere seemed to be asking the same questions.

    "How do you open that black box? How do you know what a person is thinking? How do you do it? It was just not approachable," he says. "And then the magic happened. In the late '80s and early '90s it became possible to image brain activity."

    So-called functional MRI scans and PET scans began to show which parts of the brain become active when people see pictures or read words or think about certain things.

    But scientists didn't start applying these technologies to autism until the late 1990s, when the National Institutes of Health began to pour tens of millions of dollars into autism research.

    By this time, Just had teamed up with Minshew, the neurologist who'd helped diagnose Hudale more than a decade earlier. The two researchers suspected that images of working brains could show how the brain of a person with autism is different.

    But to find out, they needed lots of people with autism who would be willing to lie in the noisy tunnel of an MRI tube and perform mental tasks over and over. And that's where people like Hudale became really important.

    Just says scans of people without autism have showed him that in a typical brain, the activity in areas near the front is synchronized with the activity in certain areas toward the back.

    "It was obvious that they were working together," says Just. "I mean we all knew in some vague way that the different parts of the brain would work together, but to find this sort of beautiful rhythmic dance together was a very eye opening moment."

    When he began to study the brains of people with autism, Just realized that beautiful rhythm wasn't always there.

    "There was this lack of synchrony between the frontal areas and posterior areas," he says.

    And the lack of synchrony became quite clear when people with autism did mental tasks in the scanner like remembering faces. Just says that process usually involves many parts of the brain working together.

    "It's one thing to recognize the visual pattern, it's another, for example, to associate the emotional response to a face," Just says. "Is it a pleasant one? Is it somebody you know and like, and so on and so forth."

    Combining visual and emotional information requires areas in the front of the brain to communicate instantly with areas in the back of the brain. And that's what you see in someone with a typical brain.

    But in the brain of someone like Jeff Hudale, Just says, there would be less communication and coordination.

    That makes sense, given the vast amount of research showing that people with autism often pay less attention to faces and have difficulty reading emotions in them.

    Just and his colleagues soon came to believe that the problem could be traced to fiber tracts that connect key areas in the front of the brain to key areas in the back. The connections just weren't good enough.

    Just says it helps to think of the brain as being a bit like the Internet.

    "The Internet would be nothing without cabling and wi-fi," he says. "It's the fact that we have this fabulous connectivity that lets our smartphones and computers connect to each other and get information back and forth quickly."

    Hudale has a more succinct version of what's become known as the "underconnectivity theory of autism."

    "Well, I'll put this to you simply, like, if I'm messed up it's because my wires are messed up," he says.

    When Just and Minshew first proposed the underconnectivity theory a few years ago, it attracted some skepticism. But recent evidence supports the theory.

    For example, a new type of scan that shows the fiber tracts connecting various parts of the brain confirms that some of the tracts are less robust in people with autism.

    If connections really are the problem, there are tantalizing hints of a partial solution. A study of dyslexia has shown that when people do mental exercises that use certain fiber tracts, the connections get stronger.

    Hudale says he's not sure whether mental exercises will help people with autism. But he says he'll keep volunteering for autism studies until something does.

    "I don't want to quit until they finally can get this set right and get this thing eradicated," he says. "I'd like to have some semblance of, just be a regular person like everybody else.

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