The federal government has announced a new rule that guarantees the rights of patients and families to sue long-term care facilities.

The rule, released Wednesday by the Centers for Medicare & Medicaid Services, bans so-called pre-dispute binding arbitration clauses in nursing home contracts, which require patients and families to settle any dispute over care in arbitration, rather than through the court system.

The rule applies to facilities that receive money from Medicare or Medicaid — which is nearly all of them.

“Today’s rules are a major step forward to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs,” Andy Slavitt, the acting administrator for the agency, wrote in a blog post about the decision.

It is scheduled to go into effect in November.

The change was originally proposed in July 2015, and Slavitt writes that the agency has “received and reviewed almost 10,000 comments from the public.”

The rule would address cases like that of Dean Cole, who NPR reported on in 2015. Just two weeks after Cole’s wife arranged for him to move into a Minnesota nursing home, he was rushed to the hospital, severely dehydrated and in a coma, a lawyer for the family told NPR’s Ina Jaffe.

Cole died a short while later. His wife, Virginia, could not sue the facility because she had signed a binding agreement to pursue arbitration for any dispute. Although she won the arbitration hearing before three judges, the fees for the proceedings amounted to more than $60,000, leaving her with a final settlement amount of only $20,000, her lawyer said.

The new rule will allow people like Virginia Cole to sue a nursing home in court. It also leaves the door open to arbitration in individual cases if both sides agree to it.

A 2009 study commissioned by the American Health Care Association, which represents most nursing homes, found the average awards after arbitration were 35 percent lower than if the plaintiff had gone to court.

The American Health Care Association opposed the arbitration rule change when it was proposed in 2015. Clifton Porter II, the AHCA’s senior vice president for government relations, defended arbitration in a 2015 interview with NPR, saying “it actually allows consumers to get an expedited award.”

The association’s president and CEO, Mark Parkinson, said in a statement, “AHCA is extremely disappointed that CMS included in the final rule a provision banning all pre-dispute arbitration agreements. That provision clearly exceeds CMS’s statutory authority and is wholly unnecessary to protect residents’ health and safety. We are considering the appropriate steps to take in light of this unjustified action by CMS.”

In addition to the litigation changes, the new rule also includes expanded regulations regarding the food, medical treatment and personnel requirements for long-term care facilities. Nursing homes must provide “nourishing, palatable” food for residents and develop a care plan for each resident within 48 hours of their admission to the facility.

Amid increased fears of institutionally-spread infection and antibiotic resistance, the new rules also require nursing homes to develop an “infection prevention and control program,” and a plan for monitoring the use of antibiotics.

Let’s block ads! (Why?)

After nearly seven months of bickering and finger-pointing, Congress on Wednesday agreed to allocate $1.1 billion to help fight the spread and effects of the Zika virus.

The deal is part of a broader agreement to continue to fund the government after the fiscal year ends on Friday and the current budget expires.

It brings to an end a partisan fight that has had the unusual effect of delaying funding to deal with what all sides agree is a public health emergency. The delay came out because of disagreement over side issues like funding for Planned Parenthood and whether the money should be considered “emergency” spending.

Wednesday’s deal drops language barring the money from going to Planned Parenthood clinics. The Senate passed the measure Wednesday; it is pending in the House.

“Women’s health should never be treated like a political football,” said Sen. Patty Murray, D-Washington, who is the ranking member of the Senate’s Health Education Labor and Pensions Committee. “I am glad that Republicans finally agreed to set aside the extreme provisions that would have specifically blocked Planned Parenthood health care providers from accessing critical funding.”

More than 23,000 people in the mainland U.S. and Puerto Rico have contracted the Zika virus, according to the Centers for Disease Control and Prevention. That includes more than 2,000 pregnant women, which is especially troubling because the virus can cause birth defects.

The CDC estimates that 20 babies in the mainland U.S. and 1 baby in Puerto Rica have been born with birth defects related to Zika.

The Zika virus can cause microcephaly — a condition where a baby’s head and brain are undersized and underdeveloped — in as many as 13 percent of babies born to women who get infected while pregnant. It is also linked to several other types of birth defects, and to Guillain-Barre syndrome in adults.

The deal reached in Congress includes $394 million to help control Zika-carrying mosquitoes and another $397 million to help develop a vaccine against the virus and better tests to help diagnose cases of Zika.

There is also $66 million allocated to health care for people affected by Zika in Puerto Rico and other U.S. territories.

President Obama asked for $1.9 billion in emergency federal funding back in February to fight Zika. The administration has been using money shifted from other accounts, including money that had been specified for studying and fighting Ebola, and for state-level emergency preparedness, to address the Zika threat.

Earlier this month Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, warned that his agency would run out of funds to fight Zika by Friday. Health and Human Services Secretary Sylvia Burwell issued a similar warning in August.

Let’s block ads! (Why?)

Eating well has many known benefits. But a good diet may not be able to counteract all the ill effects of stress on our bodies.

A new study, published in Molecular Psychiatry, suggests stress can override the benefits of making better food choices.

To evaluate the interactions between diet and stress, researchers recruited 58 women who completed surveys to assess the kinds of stress they were experiencing. The women also participated in what researchers call a “meal challenge,” where they were each given two different types of meals to eat, on different days.

One meal was high in saturated fat, the type of fat linked to cardiovascular disease. The other meal was high in a plant-based oil, which is considered more healthful.

“When women were not stressed and they got the healthier meal, their inflammatory responses were lower than when they had the high saturated fat meal,” explains study author Janice Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at the Ohio State University. She says this was not a big surprise.

But here’s the part that may seem counterintuitive: “If a woman was stressed on a day when she got the healthy meal, she looked like she was eating the saturated fat meal in terms of her [inflammation] responses,” Kiecolt-Glaser explained.

In other words, the more healthful meal was no better in terms of its impact on inflammation. “The stress seemed to boost inflammation,” Kiecolt-Glaser explained.

The kinds of stressful events the women experienced weren’t life-threatening. Rather, they’re the sorts of events that make us feel overwhelmed or out of control, such as a child care scramble or caring for an elderly, sick parent.

The researchers measured several markers of inflammation in the body, including C-reactive protein, or CRP.

Over a lifetime, higher inflammation levels are linked to an increased risk of a range of diseases, including “cardiovascular disease, Type 2 diabetes, arthritis, some cancers,” Kiecolt-Glaser explains. “It’s an ugly list of possibilities.”

The findings add to the evidence that stress is a powerful player when it comes to influencing our health. Kiecolt-Glaser’s prior research has shown that people who are stressed heal wounds more slowly. She has also demonstrated that stress can promote weight gain by altering metabolism and slowing down calorie-burning.

Kiecolt-Glaser says there’s still a lot that’s unknown. For instance, in this new study, she’s not sure how the inflammation levels of stressed-out women would have been influenced by an ultra-healthful meal — say, an avocado with greens on a piece of whole-grain toast. She points out that both of the meals the women ate for this study were very high in calories and had about 60 grams of fat.

Now, if you’re looking for the upside in this line of research, rest assured: There are a whole range of strategies that have been shown to help manage stress.

“Close, personal relationships are perhaps the world’s greatest stress reducer,” Kiecolt-Glaser says. Studies of mindfulness meditation and yoga have also been shown to be effective.

And as we’ve reported, even doing nice things for others can help keep stress in check.

When I was reporting this story, I asked stressed-out Georgetown University law students what they do to manage stress. They pointed to a range of activities — from salsa dancing to listening to hip-hop to going to the gym. “I really enjoy exercising when I’m stressed. It gives you an outlet to distract you,” Marina Smith told me.

And it seems these students are on to some good strategies, says Aric Prather, an assistant professor at the University of California, San Francisco School of Medicine, who studies how lifestyle choices influence health. “Exercise and social connectedness,” he says, “are effective in improving people’s well-being and their ability to cope with stress.”

Let’s block ads! (Why?)

Donald Trump and Hillary Clinton went head to head Monday night in the first presidential debate.

NPR’s politics team, with help from reporters and editors who cover national security, immigration, business, foreign policy and more, live annotated the debate. Portions of the debate with added analysis are underlined in yellow, followed by context and fact check.

You can follow more highlights of the debate at nprpolitics.org.

Note: The transcript on this page was updated live as the debate proceeded. We are working to correct the transcript as it comes in, but owing to the live nature of the event, there may be some discrepancies.

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Almost two decades ago, Dr. Lars Aanning sat on the witness stand in a medical malpractice trial and faced a dilemma.

The South Dakota surgeon had been called to vouch for the expertise of one of his partners whose patient had suffered a stroke and permanent disability after an operation. The problem was that Aanning had, in his own mind, questioned his colleague’s skill. His partner’s patients had suffered injuries related to his procedures. But Aanning understood why his partner’s attorney had called him as a witness: Doctors don’t squeal on doctors.

The attorney asked the key question: Did Aanning know of any time his partner’s work had been substandard?

“No, never,” Aanning said.

Now, Aanning, in a stunning admission for a medical professional, has a blunter answer: “I lied.”

While it’s impossible to know to what extent Aanning’s testimony influenced the outcome, the jury sided in favor of his colleague — and, ever since, Aanning said, he has felt haunted by his decision.

Now, 77 and retired, he decided to write about his choice and why he made it in a recent column for his local newspaper, The Yankton County Observer. He also posted the article in the ProPublica Patient Safety Facebook group. Aanning, who is a member, called it “A Surgeon’s Belated Confession.”

“From that very moment I knew I had lied — lied under oath — and violated all my pledges of professionalism that came with the Doctor of Medicine degree and membership in the [American Medical Association],” Aanning wrote.

Aanning, who has become an outspoken patient advocate, now assists the medical malpractice attorney who represented the patient in the case in which he lied for his partner.

There’s no way to tell how often doctors lie to protect their colleagues, but ProPublica has found that patients frequently aren’t told the truth when they are harmed. Studies also show that many physicians do not have a favorable view of informing patients about mistakes and that health care workers are afraid to speak up if things don’t seem right. Many doctors and nurses have told ProPublica that they fear retaliation if they speak out about patient safety problems.

ProPublica spoke to Aanning about his unusual column and why he decided to confess all these years later. The interview has been edited for clarity and length.

Why did you tell the lie?

I did it as a matter of course. And I did it because there was a cultural attitude I was immersed in: You viewed all attorneys as a threat, and anything that you did was OK to thwart their efforts to sue your colleagues. I just accepted that as normal. It wasn’t like, “I’m going to lie.” It was, “I’m going to support my colleague.”

Did you feel pressure from your peers to never criticize a colleague?

Pressure is the prevailing attitude of the medical profession. The professional societies like the AMA and the American College of Surgeons say you should be a patient advocate at all times. But that goes out the window because here you are, banding together with your peers. Because if you don’t, you’ll be like a man without a country.

Why are you telling the truth now?

I’m retired now. The big benefit is they can’t hurt me, but I can’t go to the clinic for any help. All my doctors are out of town. I came to America from Norway in ’47 and grew up in New York. I’ve always been a rabble-rouser. This testifying falsely at this trial was not like me, so it stands out. It’s not how I do stuff.

I also told the truth about my lie because I have been helping some of these plaintiffs’ lawyers with their cases. It seems that the courtroom is not the arena for adjudication of medical right or wrong. I shared my story to give an explicit example of why you can’t always rely on physician testimony in court. I think that’s the big reason. There’s got to be a different way to help people who have been medically harmed. Looking to the legal system is like mixing oil and water.

Do you feel like it’s your fault the patient lost the case?

I haven’t touched on that question. It would make it painful for me. I would be moved to tears if that whole case revolved around just my testimony. I was on the stand so briefly. But cumulatively between what I said and the other testimony — it was never a level playing field for the plaintiff. People don’t recognize it. How the judges don’t recognize it and the system doesn’t recognize it is beyond me. It’s something I’m coming to grips with.

Have you thought about talking to the patient’s family?

The attorney said something about meeting the patient’s widow in his office, or something like that. I worry about whether my testimony weighed on the final verdict or not. It’s something that you just have to face up to. It’s too late to deflect it.

Do you feel any better or worse now that you’ve gone public with your moral failure?

I’m not altruistic. I’m not a crusader. I got into writing this column accidentally, so I just kind of find myself in this position. I get a great satisfaction out of defining what I see and writing about it. I hope nobody’s going to come back at me and accuse me of bad conduct. Although that’s what it was. I felt bad about it.

ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its Patient Harm Questionnaire and Patient Safety Facebook Group. You can follow Marshall Allen on Twitter: @marshall_allen.

Let’s block ads! (Why?)

The drug company that makes the EpiPen says it isn’t nearly as profitable as many people assume it is.

At least that’s the message Mylan NV CEO Heather Bresch will try to deliver to members of Congress today.

Bresch, who is scheduled to testify before the House Oversight and Government Reform Committee, is expected to tell lawmakers that the company earns $100 profit on each two-pack of EpiPen auto-injectors, even though they carry a $600 price tag.

“The misconception about our profits is understandable, and at least partly due to the complex environment in which pharmaceutical prices are determined,” Bresch says in prepared testimony. “The pricing of a pharmaceutical product is opaque and frustrating, especially for patients.”

Bresch says it costs the company about $69 to make two EpiPens, and after rebates and fees, Mylan receives $274 per EpiPen pack. She says other, unnamed costs absorb an additional $105, leaving $100 in profit for the company.

While the company apparently is looking to use the analysis to downplay its profits, analysts say the margin is still quite high.

Ronny Gal, a pharmaceutical industry analyst at the investment firm Sanford Bernstein, says Bresch’s numbers mean Mylan makes a 40 percent profit margin on the device.

The EpiPen is a long, plastic tube that automatically injects a dose of epinephrine — or adrenaline — into a person’s thigh to stop an allergic reaction. It’s easy to use and portable.

Mylan bought rights to the EpiPen in 2008 and launched an aggressive marketing and awareness campaign. That effort has made the so-called auto-injector a must-have for anyone with a serious allergy — perhaps to bee stings or tree nuts — that may trigger anaphylaxis, a life-threatening reaction in which the airways swell and close.

The company has come under fire in recent months, however, because it raised the price of the device, which has been available for decades, more than 500 percent.

The wholesale price of a single pen was about $47 in 2007, and it rose to $284 this summer, according to Richard Evans, a health care analyst at SSR. But consumers can no longer buy a single pen, so the retail price to fill a prescription today at Walgreens is about $634, according to GoodRX.

Mylan has tried to quell the criticism first by offering customers a coupon worth up to $300 to offset the price of the device, and then announcing it would bring a generic version of the EpiPen to market for half the retail price.

In addition to the investigation by the House Oversight committee, at least three senators have also called for investigations into Mylan’s pricing practices. Sens. Charles Grassley, R-Iowa, and Richard Blumenthal, D-Conn., have sent letters to Mylan demanding an explanation for the increase.

Mylan responded with a letter that Grassley, in a press release, said was “incomplete.”

Sen. Amy Klobuchar, D-Minn., has asked the Federal Trade Commission to investigate whether Mylan has violated antitrust laws in its marketing of the EpiPen.

And the Senate Finance Committee is reviewing the rebates that Mylan offered to the Center for Medicare and Medicaid Services.

In her testimony, Bresch says the company did not intend for its price hikes to hurt patients.

“Looking back, I wish we had better anticipated the magnitude and acceleration of the rising financial issues for a growing minority of patients who may have ended up paying the full [Wholesale Acquisition Cost] price or more,” she says. “We never intended this.”

Let’s block ads! (Why?)

Many people struggling with opioid addiction can’t find a doctor to provide medication-assisted treatment, even though it’s highly effective. One reason could be that doctors who are qualified to prescribe the medication typically treat just a handful of patients.

Researchers at the RAND Corporation looked at pharmacy records from the seven states with the most doctors approved to prescribe buprenorphine, which helps people manage cravings and avoid withdrawal. They found 3,234 doctors who had prescribed the drug, also known as Suboxone, to new patients from 2010 to 2013. The median number of patients by a doctor treated each month was 13. About half of the doctors treated 4 to 30 patients; 22 percent treated less than 4; 20 percent treated 31 to 75.

“We were really surprised,” says Dr. Bradley Stein, a psychiatrist and lead author of the study, which was published Tuesday in JAMA, the journal of the American Medical Association. “We found that only about 10 percent of doctors were what we would call heavy prescribers, with more than 75 patients a month.”

Only a fraction of the 4 million people thought to abuse prescription painkillers or heroin in the U.S. are getting medication-assisted treatment.

There’s been a big push to make it easier for doctors to prescribe buprenorphine, including new rules announced by the Obama administration in July that raised the number of patients a doctor can treat from 100 to 275. But this data suggests that those limits aren’t the only barrier to getting treatment to more people.

The researchers also were surprised to find that most patients weren’t prescribed buprenorphine for very long, even though it can be used long term. The mean length of prescribing was 53 days per patient.

“This really brought home for us the need for multiple approaches, so doctors are willing and able to prescribe buprenorphine,” Stein says.

Urban areas have typically been better equipped to provide treatment for opioid addiction, whether with methadone clinics or with buprenorphine, which people can take at home and doesn’t require people a daily clinic visit. But many people struggling with opioid addiction live in smaller cities or rural areas where physicians have little experience with treating addiction to heroin and prescription opioids.

That includes towns like Bridgton, Maine, where family physicians shied away from treating addicts until they realized that their own patients were the ones overdosing and dying.

Just taking an online course on how to prescribe buprenorphine won’t be enough for many providers, Stein says, especially since many patients with opioid addiction also have other problems that need care. “We really need to think about providing mentorship, providing consultation, providing clinical support,” Stein says.

Medication-assisted treatment is supposed to include counseling, and that can be hard to find, especially in rural areas. “So we may need to think about telehealth or online counseling,” Stein says. “We may need to be creative to have people receive effective treatment, no matter where they live.”

Treatment can work, “People can recover. They go on to live incredibly productive lives. And we want to have the high-quality treatment to get them there.”

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Deepa Malik was about to make history. Seated in a custom-made chair on a hot day in Rio, Malik — paralyzed from the chest down — held a 6.5-pound shot put between her neck and right shoulder. She took a deep breath and hurled the shot 15 feet across the throwing circle. The throw got Malik a silver at the Paralympic Games in Brazil this past Monday — and made her the first Indian woman to win a Paralympics medal.

“My first thoughts were, ‘Oh my God, have I really won?’ ” says Malik, 45, via email. She developed a spinal tumor in her early 30s and has been paralyzed since. “To become the first Indian woman to win a Paralympic medal is an honor, and it is something I will cherish for the rest of my life.”

A few days later, Devendra Jhajharia also had a historic win at the Summer Games. When he was 8, Jhajharia touched a live wire in his small North Indian village; his left arm had to be amputated. Everywhere he went, people commented on his missing limb, telling his mother he would forever have to rely on her. Tired of being called weak, Jhajharia was determined to prove them wrong.

And boy, did he ever. The 36-year-old javelin thrower just beat his own 2004 Athens Paralympic record and won a Paralympic gold for a second time.

Malik and Jhajharia are part of a team of 19 athletes representing India at the 2016 Paralympic Games and proof of a change that’s taking over the country. In fact, this modestly sized group is India’s largest-ever Paralympic delegation. (China sent the largest delegation of 308 athletes; Brazil sent the second largest at 285; and at 279, the U.S. had the third largest.)

“It’s fabulous,” says Deepthi Bopaiah, executive director of GoSports Foundation, a nonprofit organization that funds professional athletes in India. “This is definitely a great start for India. I think more people will come forward to support these athletes.”

A year ago, the foundation launched an exclusive program for India’s para-athletes, and that program has funded most of the participants at this summer’s Paralympics.

So far, India has won two golds, one silver and one bronze medal. That’s double the success of its 2016 Olympic counterpart of more than 100 athletes.

Several factors have led the country to this summer of excellence. For starters, the Indian government recently passed a first-of-its-kind corporate social responsibility law requiring certain companies, based on their earnings and revenue, to contribute 2 percent of their profits to social development — including education, poverty and sport programs. “It’s really changed the game for us,” says Aparna Ravichandran, head of partnerships at GoSports Foundation.

Since its inception eight years ago, the foundation has relied on the support of individuals and small organizations, but this recent mandate has resulted in funding from multinational companies and other large partners. The government also launched a “Target Olympic Podium Scheme,” an initiative that has set aside a little over 300 million rupees, or more than $4 million, for the program.

These cash incentives have made a world of difference to athletes — several of whom are from extremely humble backgrounds. They also convey to a society that’s biased toward academics that sport can be a legitimate and lucrative career.

“They’re able to see money,” Bopaiah says, adding that athletes can win hundreds of thousands of dollars through sponsorships as well as rewards from the government. For instance, the government of Tamil Nadu in southern India has promised high jumper Mariyappan Thangavelu 20 million rupees, close to $300,000, for winning a gold in this year’s Paralympics.

Policy changes have also led to better media coverage and more awareness of the needs of athletes with disabilities. A few years ago, Mahantesh Kivadasannavar, a partially blind cricketer, helped form the Cricket Association for the Blind in India, or CABI, with “the prime objective to focus on promoting and fostering the game of cricket for the blind,” he says. This relatively new group — still in need of regular funding — is managed by visually impaired cricket enthusiasts.

Para-cricket involves slight modifications to the original sport. For instance, the cricket ball is made of plastic with steel ball bearings on the inside that rattle, letting the batter know of an approaching ball. Also, cricket wickets are made of steel instead of wood. In a country that worships cricket, CABI helps select 17 visually impaired cricketers from a group of roughly 10,000 hopefuls to represent India at international events — including the second annual T20 World Cup cricket tournament for the blind scheduled for early next year.

Kivadasannavar is also part of the Indian Association of Para Sport Organizations — a recently formed coalition of like-minded groups and agencies.

The group is the brainchild of Rajesh Tomar — former president of the Paralympic Committee of India, or PCI, which has often come under criticism. PCI’s parent body, the International Paralympic Committee, suspended the organization several times in the past few years over internal conflicts as well as mismanagement of athletes and events.

Only recently did the international arm lift its ban on PCI, allowing athletes to represent India at this summer’s Paralympics.

The poor planning manifests itself in other ways, too. “There’s not much help in terms of sending in their entries, paying their entry fee on time, getting their visa, getting their travel documents processed on time,” says Ravichandran of GoSports.

In addition, despite some improvements, athletes continue to struggle with a lack of handicap-accessible infrastructure and access to appropriate training facilities in India. “The deeper we got into that ecosystem, the clearer it became that there’s so much more support needed,” she says.

Some of that support comes from coaches and other role models, who have already walked this somewhat confusing and challenging path.

Niranjan Mukundan can vouch for the power of a good coach. Born with a spinal defect and a club foot, this 22-year-old swimmer was crowned junior world champion last year at the International Wheelchair and Amputee Sports event in the Netherlands. It was “one of the best moments of my life,” he says.

When Mukundan was 8, his coach, John Christopher, from Bangalore, introduced him to the world of para-swimming. Less than a year later, Mukundan participated in his first national event and won a silver medal.

When she isn’t out winning medals for her country, Malik serves as a motivational speaker and a role model, hoping to inspire people through her journey.

“I think it is important to lead as an example,” she says. “Now, with my latest achievement, I hope to strike a chord with people back home — particularly differently abled women in India — and inspire them to come out of their homes.”

Let’s block ads! (Why?)