While Congress fidgets over whether and how to pay for the fight against the Zika virus, state and local health departments are scrambling and slimming down.

That’s because these front-line public health agencies have already seen their budgets chopped because of the debate.

The Centers for Disease Control and Prevention in April cut $44 million from its fund that helps state and local governments prepare for public health emergencies. It was part of the $589 million the White House moved from other programs – mostly money allocated for domestic and international responses to the Ebola virus – to combat Zika as it awaited action on Capitol Hill.

New York City’s health department lost $1.1 million in the deal.

Marisa Raphael, the deputy commissioner in New York’s Office of Emergency Preparedness and Response, says she expects to have to cut jobs.

“We depend on this grant to create an infrastructure for our preparedness and our response,” Raphael tells Shots. “That’s everything from our lab staff to our surveillance staff, so when we have this cut, that does immediately impact our capabilities.”

New York isn’t unique. A survey of state and local health departments shows that many are struggling with the reduced funding. About a third of state health departments say they expect to lay people off, and the same number say they’ll likely eliminate training programs.

The cuts will affect the kinds of things these departments normally do.

“A new measles outbreak? That’s the job of the health department to discover and to control,” says Thomas Inglesby, the CEO of the Center for Health Safety at the University of Pittsburgh Medical Center. “Or a new mumps outbreak on a college campus, or a meningitis outbreak. That’s the day-in, day-out work of public health.”

He says public health department budgets have been slashed over the last 10 years and they just don’t have excess resources or people that can be cut.

“If you take funding from local health department preparedness that means people are fired or labs can’t run the same way or disease surveillance has to stop,” he says. “If we take people from those jobs to work on Zika, that will help with Zika, but that will hurt our other preparedness efforts.”

President Obama in February made an emergency request of $1.9 billion to combat the Zika virus. The money would be used for research into a new vaccine, treatments and tests for the disease as well as to study and track how it spreads and try to control the population of mosquitoes that carry the virus.

Scientists agree that the Zika virus is linked to microcephaly, a condition in which babies are born with undersized brains and skulls. It is also linked to several other types of birth defects, and to Guillain-Barre syndrome in adults.

The House of Representatives this week passed a bill allocating $622 million for Zika response, about a third of the president’s request. And all of the money comes from other programs.

House Appropriations Committee Chairman Hal Rogers, R-Kentucky, argued at a recent markup that the emergency money was a stopgap until Congress could allocate more money as part of the regular budget process.

The Senate is working on a separate bill that would provide $1.1 billion in new money for the disease.

Public health experts argue that three months is a long time to wait for what many say is an impending public health emergency.

And since Zika is just the latest in a string of infectious disease threats, many public health experts want to create a standing fund for public health emergencies.

Such a fund could operate like the one maintained by the Federal Emergency Management Agency. The agency can draw on it as needed in an emergency; it would be replenished in the regular government budgeting process.

Anthony Fauci, the director of the National Institute for Allergies and Infectious Diseases, part of the National Institutes of Health, and Thomas Frieden, the director of the CDC, advocated for such a fund in recent weeks.

“The whole idea is to have funding available urgently when it is needed urgently,” says Melinda Moore, associate director of the Population Health Program at the Rand Corporation.

She says FEMA money is “available as soon as it’s needed, right on the heels of a hurricane, a tornado, et cetera. Some of these outbreaks — and Zika is a good example — are nearly as urgent as that.”

Inglesby agrees that an emergency fund would eliminate these repeated budget fights.

But for Zika that debate is too late, he says. Congress should allocate emergency money for Zika now and then treat is as a regular part of our public health landscape.

“Zika is the new normal,” Inglesby says. “Zika is something we’re going to have to deal with not just this summer, but next summer and the summer after that.”

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A single question asked at an annual checkup — whether parents have trouble making ends meet — could help pediatricians identify children at risk for serious health problems associated with poverty and the chronic levels of stress that often accompany it.

The American Academy of Pediatrics urges members to ask if their patients’ families are struggling financially and then commit to helping them get the resources they need to thrive. And some communities are trying to make that happen.

Since almost half of young children in the United States live in poverty or near poverty, it’s no small challenge.

The Center for Youth Wellness, located in San Francisco’s low-income Bayview Hunters Point neighborhood, is working with the pediatricians’ organization on a national campaign, Children Can Thrive, to raise awareness about the impact of a range of childhood stressors, known as adverse childhood experiences, or ACEs. These experiences of abuse, neglect or household dysfunction can have grave implications for both child and adult health.

In screening children for ACEs, the Center recognizes a “high relationship” between low incomes and harmful stressors. Although children from any economic status can live with ACES, exposure is greater for children who live in poverty, says Mark Cloutier, executive director of the Center.

The ACE screening test is simple; 10 questions that an adult or child can answer in a few minutes. (You can take it below.) But doctors aren’t taught about ACE scores in medical school, and some are reluctant to give patients the test because they think it’s too invasive or brings up problems that can’t be treated. That’s not true, researchers say.

Knowing that a child lives in poverty “changes everything,” says Dr. Susan Briner, medical director at the Bayview Child Health Center. Briner knows to expect that there may be more emergency room visits in families with low incomes “because if parents miss a day of work for an office visit, that can be catastrophic to their housing or family budget.”

Earlier this year the AAP, which represents 64,000 pediatricians, published a policy statement and technical report on how poverty affects children’s health in the academy’s journal Pediatrics. Lead author James Duffee, a child psychiatrist in Columbus, Ohio, says the policy represents “a new emphasis on the health of children in communities, trying to get pediatricians to think broadly about the context in which a child is born.”

According to the report, poor children have higher rates of low birth weight, infant mortality and chronic illnesses such as asthma, Type 2 diabetes and obesity.

According to Duffee, toxic stress has also been proved to disrupt the architecture of the developing brain, damaging the prefrontal cortex, which is responsible for impulse control, planning and thinking about consequences.

But the effects of poverty can be mitigated, and that’s where early intervention can help. “There is a way that we can change toxic stress into tolerable stress,” says Duffee. He cites the developing science on resilience, which shows that growing up in a close, supportive relationship with an emotionally attached adult can help a child overcome adversity.

By promoting those early attachments, pediatricians and other adults can help young people develop protective factors and head off potentially serious health effects. “One of the changes in pediatric practice is looking for ways we can promote relational health and not just physical or medical health,” says Duffee.

Families aren’t as averse to talking about their economic situation as doctors may think.

“I think it’s a great question to ask,” says Lottie Titus, a San Francisco resident who shares parenting of her three grandchildren. Titus says talking about finances with a family doctor “can establish why there are so many illnesses, so many challenges, so much depression.”

Titus’ grandkids “have been exposed to a lot,” she says. “All their lives they’ve lived in public housing.” The children, ages 10 to 14, also have health problems, from Type 1 diabetes to asthma and emotional problems. All three children see a therapist.

They are also involved in community programs such as Big Brothers Big Sisters of the Bay Area and the youth development organization City of Dreams. Titus said it was the children’s pediatrician who ensured that Titus was connected with these services: “She referred me to many programs that have been beneficial to the children, pointing them in the direction of the services that they needed, that helped them to be well-rounded.” Titus has since become a community liaison with City of Dreams, providing information and resources to youth and families living in San Francisco public housing.

That’s the model of engaged pediatric practice the pediatricians hope to see replicated nationwide.

This story was produced by Youth Today, a national news source for youth-service professionals, including child welfare and juvenile justice, youth development and out-of-school-time programming.

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Scientists and doctors say the case is clear: The best way to tackle the country’s opioid epidemic is to get more people on medications that have been proven in studies to reduce relapses and, ultimately, overdoses.

Yet, only a fraction of the more than 4 million people believed to abuse prescription painkillers or heroin in the U.S. are being given what’s called medication-assisted treatment.

One reason is the limited availability of the treatment. But it’s also the case that stigma around the addiction drugs has inhibited their use.

Methadone and buprenorphine, two of the drugs used for treatment, are themselves opioids. A phrase you often hear about medication-assisted treatment is that it’s merely replacing one drug with another. While doctors and scientists strongly disagree with that characterization, it’s a view that’s widespread in recovery circles.

Now, the White House is pushing to change the landscape for people seeking help. In his 2017 budget, President Obama has asked Congress for $1.1 billion in new funding to address the opioid epidemic, with almost all of it geared toward expanding access to medication-assisted treatment.

The White House is also highlighting success stories. At the National Prescription Drug Abuse and Heroin Summit held in Atlanta in March, President Obama appeared on stage with Crystal Oertle, a 35-year-old mother of two from Ohio. Oertle spoke of her spiral into addiction, which began with prescription painkillers and progressed to heroin. She tried unsuccessfully to quit on her own several times, before being prescribed buprenorphine a year ago. “I personally couldn’t get through the withdrawal symptoms,” Oertle said in Atlanta. “I couldn’t tough it out. I know some people can. I couldn’t do it. This last time has been the most successful recovery for me.”

Her experience isn’t unique.

“I’ve seen people with opioid-use disorders go through inpatient treatment without medications time and time and time again, without ever being offered alternatives,” says Michael Botticelli, director of National Drug Control Policy at the White House. “We wouldn’t do that with any other disease. If one treatment failed for you, we’d say, let’s look at other possible treatment options.”

David Lidz runs the organization Ladders to Leaders in Hagerstown, Md., where he offers both beds and jobs for men transitioning out of drug treatment. Meredith Rizzo/NPR hide caption

toggle caption Meredith Rizzo/NPR

Botticelli says patients should consider the evidence for medication-assisted treatment and together with their doctors make a decision about what’s best for them.

Methadone and buprenorphine have been tested in scores of clinical trials. Researchers have found that when combined with counseling, they significantly reduce opioid use and keep people in treatment longer.

“We have tons of experience with patients who remain in treatment for months and years, who do very well on relapse-prevention medicines,” says Dr. Marc Fishman, medical director at Maryland Treatment Centers in Baltimore. He says among his patients, primarily young people, about half remain with the program six months into treatment. Studies have shown far worse outcomes for patients who detox without follow-up medications, with relapse rates topping 90 percent.

Still, there are many people who stand by the so-called abstinence route — recovery without the use of medications. Their views are informed by personal experiences and deeply-held beliefs about what constitutes true recovery.

For years, Juan Ramirez, 56, led a high-risk lifestyle to support his use of prescription painkillers. “When you start robbing drug stores and drug dealers because of your drug habit, your life is not working right,” he says.

A friend told Ramirez about a doctor in Baltimore who prescribed Suboxone, a brand of buprenorphine. He liked the way Suboxone made him feel, so he would often exceed the dosage, buying pills from other patients so he wouldn’t run out. The good news was he stopped using other narcotics and, overall, he felt more functional. Still, after three years of seeing the doctor, he never felt like he’d achieved full recovery. “I was still an addict,” he says. “It was just legal.”

Lidz runs a group home in Hagerstown, Md., for men who are moving from drug treatment back into daily life. Meredith Rizzo/NPR hide caption

toggle caption Meredith Rizzo/NPR

That line of thinking extends to some people whose mission is to help people in recovery, including David Lidz, a recovering alcoholic, who runs a group home in Hagerstown, Md. The home has 10 beds for men who are transitioning out of intensive drug treatment back into daily life. In addition to beds, Lidz offers the men work with his contracting business, refurbishing houses. The emphasis is on hard work, personal responsibility and purpose. It’s what worked for Lidz in his recovery, but even he knows it doesn’t work for everyone.

When he started his work as a recovery advocate, Lidz knew little about medication-assisted treatment and had yet to form an opinion about it. Soon, he started getting reports from the group home that someone’s Suboxone had been stolen, or someone looked high, or that people were trading, selling, and snorting Suboxone. “That to me just looks like heroin,” Lidz says.

So he made a decision: He wouldn’t accept anyone on it.

Today, that stance is threatening the group home and his business. “Now we’ve been told by clinical settings that we’re essentially blacklisted, that they can’t even mention our program if we won’t take people on opiates, on Suboxone,” Lidz says.

He worries it could lead to missed opportunities for people like Charles Testerman, who came to Lidz’s group home after several months in drug treatment. Testerman describes his years of drug use as “doing everything to excess.” He drank, smoked marijuana, and got hooked on prescription painkillers and later heroin. When he couldn’t afford heroin, he bought Suboxone on the street, hoping it would help him stop using other drugs. It didn’t work.

“I was doing Suboxone in the mornings, as well as Adderall to bring myself up. Then at night, I was taking Xanax, smoking weed and drinking, just to go to sleep every night,” Testerman says. “It was just a constant cycle.”

Charles Testerman (left) learns from David Gibney how to restore an early 19th century barn in Waynesboro, Pa. Meredith Rizzo/NPR hide caption

toggle caption Meredith Rizzo/NPR

Today, he has an apprenticeship with a master woodworker at a place called The Stoner Farm, Anglicized from Steiner, the name of the family that built the place. Testerman is working to restore an early 19th century barn there. “I feel great, happy to be out here doing this,” he says. “It’s just nice to wake up in the morning and not have to do anything to feel normal.”

Testerman left an intensive drug treatment program and now lives in a group home run by Lidz. Meredith Rizzo/NPR hide caption

toggle caption Meredith Rizzo/NPR

Fishman, the addiction doctor in Baltimore, knows there are people like Testerman who find the strength to have what he calls a life-changing conversion without medications. But, he cautions, not everyone can do it, and it’s not scalable. He wants to persuade the doubters that medication-assisted treatment is the best tool available at the moment, and, in making his case, he’s willing to acknowledge its limitations.

“This doesn’t change my claim that it should be the standard of care,” he says. “But we don’t have the penicillin for addiction. These are not curative medications. In having a nuanced, thoughtful discourse with people who might disagree with us, acknowledging those limitations I think would make us more credible.”

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Last year, in an operating room at the University of Toronto, a 63-year-old women with Alzheimer’s disease experienced something she hadn’t for 55 years: a memory of her 8-year-old self playing with her siblings on their family farm in Scotland.

The woman is a patient of Dr. Andres Lozano, a neurosurgeon who is among a growing number of researchers studying the potential of deep brain stimulation to treat Alzheimer’s and other forms of dementia. If the approach pans out, it could provide options for patients with fading cognition and retrieve vanished memories.

Right now, deep brain stimulation is used primarily to treat Parkinson’s disease and tremor, for which it’s approved by the Food and Drug Administration. DBS involves delivering electrical impulses to specific areas of the brain through implanted electrodes. The technique is also approved for obsessive-compulsive disorder and is being looked at for a number of other brain disorders, including depression, chronic pain and, as in Lozano’s work, dementia.

In 2008, Lozano’s group published a study in which an obese patient was treated with deep brain stimulation of the hypothalamus. Though no bigger than a pea, the hypothalamus is a crucial bit of brain involved in appetite regulation and other bodily essentials such as temperature control, sleep and circadian rhythms. It seemed like a reasonable target in trying to suppress excessive hunger. To the researcher’s surprise, following stimulation the patient reported a sensation of deja vu. He also perceived feeling 20 years younger and recalled a memory of being in a park with friends, including an old girlfriend. With increasing voltages, his memories became more vivid, including remembering their clothes.

Using a 3-dimensional brain mapping technique called standardized low-resolution brain electromagnetic tomography, or sLORETA, Lozano’s group uncovered an explanation for the unexpected findings. They found that stimulating the hypothalamus was in turn driving increased brain activity in the hippocampus, a key cog in the brain’s memory circuitry. As Alzheimer’s progresses, not only does the hypothalamus atrophy, but electrical communication between neurons in the region also gradually becomes impaired.

That our memories — so entwined with our personalities and senses of self — might be so vulnerable to a brown out is, existentially speaking, rather alarming. There’s something palpably dehumanizing about reducing our past selves to the exchange of electricity between neurons, and also about retrieving memories by hot-wiring the brain.

Yet the prospect of the latter is undeniably intriguing. Given that Alzheimer’s affects 1 in 9 people over the age of 65 and that current therapies are in many patients dismally ineffective, Lozano felt all but obligated to dig further. His group launched a test in six patients and published the results in the Annals of Neurology in 2010.

The study included patients with mild and severe disease who received stimulation in the fornix continuously for 1 year. “The fornix is like the highway leading into the hippocampus,” explains Lozano. “It’s easier to stimulate than the hippocampus itself and crucial to memory function.” As expected those with more severe disease continued to mentally deteriorate, however it appeared that in those with mild disease, cognitive decline slowed with stimulation.

Next, Lozano launched a randomized trial involving 42 patients from the US and Canada, all of whom had electrodes implanted in the fornix on both sides of the brain. In half the patients the stimulation was turned on right away. In the other half the stimulation wasn’t turned on for a year, though they didn’t know it.

Preliminary results, published in December 2015 in the Journal of Neurosurgery, were mixed but encouraging.

Given that so few people have had electrical stimulation applied to memory circuits, perhaps the most significant finding was that both the surgery itself and DBS of the fornix appear safe. No serious long-term neurological side effects were seen in either patient group, supporting future research in the field.

In terms of efficacy, however, after one year there were no significant differences in cognition between the groups, as measured by two scales commonly used to measure Alzheimer’s disease symptoms, the ADAS-Cog and CDR-SB. Alzheimer’s tends to progress slowly and reversing or slowing the neurodegeneration associated with condition may take time to become noticeable. Lozano’s final results won’t be reported until four years out.

More intriguing for now were comparisons of glucose utilization. Glucose is our brains’ primary fuel. The degree to which glucose is burned is a commonly used measure of brain activity. Patients with Alzheimer’s typically have reduced glucose activity in their brains, as well as, again, shrinking memory circuits. The older patients in Lozano’s study who had stimulation turned on exhibited markedly increased glucose use in the brain’s memory regions. Not only that, the hippocampus of some study patients who received DBS actually increased in size.

Reversing withering hippocampi by encouraging the growth of new neurons is seen as a holy grail in Alzheimer’s research, and Lozano’s finding is supported by a recent animal study demonstrating that DBS in rats causes the release of growth factors that induce neuronal growth in the hippocampus.

Lozano acknowledges that retrieving childhood memories, which he says has occurred in about one-third of his patents — requires lofty voltages that he would be uncomfortable sending patients home on. Yet he’s encouraged by the early findings that suggest the procedure is safe. “We also know that in patients who receive stimulation there is an increase in glucose utilization in memory areas of the brain,” he says, a finding that could mean there’s a way to overcome some of the damage from Alzheimer’s.

Evidence supporting DBS in dementia is emerging from other research groups as well. A 2012 study published in the New England Journal of Medicine reported that in seven patients receiving DBS to a brain region called the entorhinal cortex, spatial memory improved – meaning they could more easily remember the locations of newly learned landmarks. The entorhinal cortex works in concert with the hippocampus to solidify memories.

A group at the University of Cologne in Germany is instead focusing on delivering DBS to a part of the brain called the nucleus basalis of Meynert, another region in which impaired neuron function is thought to contribute to Alzheimer’s. Last year they published a study in Molecular Psychiatry in which four of six patients either remained cognitively stable or improved in response to DBS, as measured by the ADAS-cog. Like in Lozano’s study no serious side effects were seen.

Despite the mounting evidence for DBS, not everyone is convinced.

Referring to Lozano’s second clinical study, Dr. Nader Pouratian, a neurosurgeon and DBS researcher at UCLA, comments, “The recent deep brain stimulation trial for Alzheimer’s disease clearly demonstrates the safety of this approach for trying to treat the progression of disease. Unfortunately, [the findings] suggest that the therapy may not be as robust as initially proposed.”

However he acknowledges Lozano’s results suggest that DBS to the fornix might be promising for a subgroup of patients, those being older people with less severe disease.

“The most promising areas are likely the fornix or the entorhinal area,” he says. “But I believe further studies are necessary to better elucidate the efficacy of this treatment before proceeding to a larger scale randomized trial.”

In a 2008 episode of the medical television drama House, the show’s main character Dr. Gregory House survives a bus crash that leaves his memory murky. In an attempt to remember the medical history of a fellow collision victim – and inspired by Lozano’s initial paper — House voluntarily undergoes deep brain stimulation. Following the procedure the grouchy TV doctor’s memory returns. As is customary on the show, he cracks the case.

DBS for treatment of Alzheimer’s and other dementias is a field in its infancy. Unlike on TV, in all likelihood it won’t be widely used anytime soon to retrieve specific memories. “Even though House did this, we’re not doing it yet,” cautions Lozano.

Yet the fact that the therapy can in some people rescue recollections – albeit random ones – and possibly induce new neuron growth in memory regions of the brain seems reason enough to pursue it further.

“We’re hoping to use electricity to drive activity in areas of the brain involved in memory and cognition,” says Lozano. “We want to turn these brain networks back on.”

Bret Stetka is a writer based in New York and an editorial director at Medscape. His work has appeared in Wired, Scientific American and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He’s also on Twitter: @BretStetka.

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Hillary Clinton is floating a proposal to let people over the age of 50 “buy in” to Medicare, the federal government’s health insurance for those 65 and older.

The Democratic presidential contender mentioned the idea earlier this week at a campaign event in Stone Ridge, Va. She was responding to a woman who said her health insurance premiums – which she bought on the individual market — rose more than $500 last year.

“What you’re saying is one of the real worries that we’re facing with the cost of health insurance,” Clinton said. “The costs are going up in many markets.”

Clinton suggested that removing older people from the market would lower costs. And their own costs wouldn’t necessarily go up, she said, because they’d be part of such a big group.

“If you were able to let people 55 or 50 [years old] and up who are the biggest users of health care into the Medicare program – they would have to buy in but they would be buying into such a big program that the costs would be more distributed,” Clinton said.

Clinton’s campaign hasn’t offered any more details.

But the mention has raised the possibility that Clinton may use the idea of a Medicare buy-in to rekindle the debate over the so-called public option – having a government health insurance plan compete with private companies.

The idea could help control health care spending, advocates say.

Jacob Hacker, director of the Institution for Social and Policy Studies at Yale University, says Clinton’s idea could slow down health care inflation because Medicare is very efficient.

“While Medicare is often criticized as not being effective enough at cost control, in fact Medicare has done a better job than private plans in restraining prices,” Hacker says.

Hacker became known as the “father of the public option” during the 2010 debate over the Affordable Care Act because he was an early proponent of the idea. He says Medicare, or another government plan, is in the best position to lower overall costs because the government can best negotiate lower payments for doctor visits, tests and medications.

“Dealing with our health care costs crisis, and it is a crisis, it’s the number one threat to our budget, is going to require putting significant pressure on the medical industrial complex,” he says.

The public option died in 2010 when Republicans and some Democrats opposed the idea of having the government compete with the medical insurance industry.

But Clinton, in her campaign materials, says she wants to bring it back.

Letting people buy in to Medicare could be a first step, Hacker says.

“If you go into the health insurance exchange, you could conceivably choose between a range of private plans and the Medicare program,” he says.

Reaching Out To Sanders Supporters

Clinton may also be broaching the idea to appeal to Bernie Sanders supporters who like his proposal to offer a government health insurance plan to everyone – which he calls Medicare for All.

Sanders’ plan has been criticized because of its potential cost. He says the plan will cost about $1.38 trillion a year and would be paid for by tax increases on individuals and employers.

Many economists dispute his estimates. A new analysis by the Urban Institute says it would cost more than twice that amount.

Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute, says a Medicare buy-in may not be as simple as it sounds.

Putting people ages 50 to 65 in a pool with the elderly could end up costing them more because they’re associated with the biggest and most expensive health care consumers.

And Medicare is more fragmented than regular insurance, with separate programs to pay for hospitals, doctors and prescriptions. So Clinton would have to decide whether to leave Medicare as is or create something more like traditional insurance for these younger customers.

“If we’re going to provide something that looks like a cohesive package for the non-elderly through Medicare then I think we need to be thinking about why we’re not doing that for the elderly as well,” Blumberg says.

Tom Miller, a resident fellow at the American Enterprise Institute, also sees unintended consequences in moving people from private insurance into Medicare.

Doctors and hospitals charge private insurers more to make up for the low payments from Medicare, he says, and Clinton’s idea just moves more of the costs from one group to another.

“It’s like saying, ‘Let’s move this pothole over to another place where you’re not driving and someone else will run into it,'” Miller says. “You can’t hide the problem, you can move it around to a different set of pockets.”

Miller says health care for people over 50 just costs a lot of money. If Clinton wants to reduce those costs, he suspects people will end up with fewer benefits, or taxpayers will end up subsidizing their insurance even more.

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Our friend and colleague Peggy Girshman, a longtime NPR editor and co-founder of Kaiser Health News, died in March. But her passion for health journalism survives her. She made sure of that.

Beyond the many journalists whose careers she launched and nurtured, Girshman wrote her own eulogy, complete with some hard-earned advice on matters of personal health and how to cover health and medicine.

NPR correspondent Rob Stein read it Saturday at a memorial service attended by more than 150 people, including a who’s who of health and science journalists, at Brookside Gardens in Silver Spring, Md.

Before and after the speeches, there were cookies — lots of cookies — baked by fellow members of her Christmas cookie club.

Mitch Berger, Girshman’s husband, gave us permission to publish her “auto-eulogy,” as she called it, which has been edited lightly for clarity and length.

There’s a common saying that, on their deathbed, no one says, “I wish I had spent more time at work.” I’m an exception to that. A central tragedy in my life is that I couldn’t work longer, if only to convince someone I was right about something.

I also wish I had divided my life to spend more time with my family, especially Beth, Helen, Irv, Natalie, Lianna and Annie, whom I order around and love like a niece. Well, maybe not much more time with my parents. And my friends, including the myriad of best friends, you all know who you are. And you’ve all been the best of friends to me, especially in the last few years.

OK, now that that’s over with, I’m taking a few minutes when you have to listen to me. I’m only sorry I couldn’t be there for your rapt attention and adherence to my advice. Here we go.

For folks with Stage 0 or less cancers, especially DCIS [ductal carcinoma in situ], or prostate, watch and wait. I understand. I was one of those people who say, “Get it out of me.” Please resist that temptation.

At least half of these don’t go on to become invasive cancers. Why should you do all kinds of bad things to your body unnecessarily? And, by the way, it costs waaaay too much.

If you are one of those people who can’t resist the call of the surgeon, do not get a lumpectomy, aka “breast conserving” surgery. I can tell you that from personal and observational experience, it doesn’t conserve the breast.

After the surgery, which often has to be done twice to get clean margins, there is the whole nightmare of radiation, which shrinks tissue and makes for painful inner scarring. Biggest mistake of my life was to do that. And there are a lot of mistakes to choose from.

If I only convince one of you to at least convince one other person, I’ve accomplished something. I know, I’ve done so much good work blah blah blah. But even one person not having surgery would be the crowning achievement of my life. I am not kidding.

Setting aside my own body (oh yeah, it really is set aside now), let’s talk a little about evidence.

If you get nothing else from this memorial service, please think about evidence, truth as best it can be determined. Anecdotal evidence is only meaningful if it involves me, Peggy Girshman. Otherwise, trust the scientific method, where similar groups are compared and with large sample sizes, if possible. Especially when it comes to what you put in your body for medicinal reasons.

OK, I know there’s a lot of eye-rolling out there right now. But why would you take anything that hasn’t been proved to work? Belief is powerful. The placebo effect exists.

While we’re at it, please stop with the lifestyle advice.

Don’t knock people about what they’re eating, how much or when. Yes, if you eat a lot of fresh fruits and vegetables and cut down on fat, you have lowered the chances you’ll get cancer or heart disease.

But that is just one of so many factors, that to judge people about their quantity of fruits and vegetables is simply unfair.

Don’t ask, if someone has lung cancer, if they smoked. Try really, really hard not to even think it in your head. It shows, believe me. It adds pain to an already painful, scary time.

Try to convince yourself that people get sick for so many reasons that we don’t know about. One little mutation in one little cell.

Two people eating the same amount of sugar or carbs every day for years: One might develop diabetes and the other doesn’t. Please don’t examine what one person is eating to cast disapproval in your head while the other one gets a pass.

When 10 studies can’t find any connection between X and Y, please believe it. Don’t think about your friend or even yourself where it seemed to go the other way. Of course it sometimes goes the other way, but why would you want to live your life based on your friend, who is lovely but might have another claim next week.

Don’t say, “I don’t know how you can find anything in your office/house/car.” In other words, wow, you’re a slob. Yes, I’m messy, what do you care? Neat, vegetable-eating people are not morally superior to anyone else.

Be nice to people. Sounds really corny and pedestrian, but it’s how I managed to succeed at work, no s***.

Always make sure there are cookies or something tasty to eat at any in-person meeting. As there should be, right now, in the back. You’ll get to them very soon, I promise.

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“In Aleppo, We Are Running Out of Coffins” was the title of an op-ed from Syrian doctor Osama Abo El Ezz. NPR’s Lynn Neary speaks with him about attacks on hospitals in Syria.

Let’s block ads! (Why?)