Health & Fitness (239)
It won't be nearly as much fun as eating candy bars, but a big study is being launched to see if pills containing the nutrients in dark chocolate can help prevent heart attacks and strokes.
The pills are so packed with nutrients that you'd have to eat a gazillion candy bars to get the amount being tested in this study, which will enroll 18,000 men and women nationwide.
"People eat chocolate because they enjoy it," not because they think it's good for them, and the idea of the study is to see whether there are health benefits from chocolate's ingredients minus the sugar and fat, said Dr. JoAnn Manson, preventive medicine chief at Harvard-affiliated Brigham and Women's Hospital in Boston.
The study will be the first large test of cocoa flavanols, which in previous smaller studies improved blood pressure, cholesterol, the body's use of insulin, artery health and other heart-related factors.
A second part of the study will test multivitamins to help prevent cancer. Earlier research suggested this benefit but involved just older, unusually healthy men. Researchers want to see if multivitamins lower cancer risk in a broader population.
The study will be sponsored by the National Heart, Lung and Blood Institute and Mars Inc., maker of M&M's and Snickers bars. The candy company has patented a way to extract flavanols from cocoa in high concentration and put them in capsules. Mars and some other companies sell cocoa extract capsules, but with less active ingredient than those that will be tested in the study; candy contains even less.
"You're not going to get these protective flavanols in most of the candy on the market. Cocoa flavanols are often destroyed by the processing," said Manson, who will lead the study with Howard Sesso at Brigham and others at Fred Hutchinson Cancer Research Center in Seattle.
Participants will get dummy pills or two capsules a day of cocoa flavanols for four years, and neither they nor the study leaders will know who is taking what during the study. The flavanol capsules are coated and have no taste, said Manson, who tried them herself.
In the other part of the study, participants will get dummy pills or daily multivitamins containing a broad range of nutrients.
Participants will be recruited from existing studies, which saves money and lets the study proceed much more quickly, Manson said, although some additional people with a strong interest in the research may be allowed to enroll. The women will come from the Women's Health Initiative study, the long-running research project best known for showing that menopause hormone pills might raise heart risks rather than lower them as had long been thought. Men will be recruited from other large studies.
Manson also is leading a government-funded study testing vitamin D pills in 26,000 men and women. Results are expected in three years.
People love vitamin supplements but "it's important not to jump on the bandwagon" and take pills before they are rigorously tested, she warned.
"More is not necessarily better," and research has shown surprising harm from some nutrients that once looked promising, she said.
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HOUSTON (AP) -- Sara Rodriguez recently received a $4,000 bill for a six-hour emergency room visit to treat a fever. She says she can't pay, but she's also not planning to buy health insurance through the new federal marketplace.
Rodriguez, like others gathered in a Houston gymnasium listening to a presentation about the health care overhaul, says she can't afford insurance, even for $50 a month. With two young children and barely $400 of income a month after paying rent, she struggles to feed her family.
"It's the law, but I'm not interested," the 27-year-old says, explaining that she attended the presentation only because her GED teacher is making her write an essay. "I cannot afford it."
The presentation ends and Rodriguez grabs her belongings and rushes out, forgoing the opportunity to make an appointment for enrollment assistance. The crowd of about 200 quickly dwindles, with some stragglers lingering to schedule appointments.
As a March 31 deadline draws near, this is a daily reality in Texas, where nearly 1 in 4 residents is uninsured, the highest rate in the nation.
Texas stands out among the nation's four most populous states for lagging behind on signups. California, New York and Florida have signed up far more people.
Enrollment helpers here are working days on end, sometimes with no time off, as they make a final push to get people to buy policies.
They count the small victories: If only five people come to a three-hour enrollment event but all sign up, that gets a thumbs' up. No matter that it is just an infinitesimal fraction of the Texans who could be eligible for subsidized coverage, a figure the Kaiser Family Foundation puts at 1.8 million people.
The final weeks of enrollment are sure to be filled with frenetic activity. Mega-enrollment drives are planned almost daily. Weekend and evening events are jam-packed. Hospitals in Dallas will stay open for longer weekday and weekend hours.
At this late stage, education and outreach have largely been abandoned. The goal now is to ensure that everyone who strolls in with paperwork walks out with insurance.
"Sign up! Sign up," is the charge guiding Benjamin Hernandez, Houston's deputy assistant health director, as he helps with a massive effort to reach his region's 1 million uninsured.
Texas' large uninsured population makes it crucial to the success of the entire national program. But the impediments are many.
Some in the state's large Hispanic population are wary of enrolling because of fears that doing so might reveal the existence of family members at risk of being deported.
As of mid-March, enrollment numbers were only slightly more than 295,000, lagging behind Florida, another state with high numbers of uninsured and a governor opposed to the program.
Texas Gov. Rick Perry has erected his own obstacles in the form of additional rules and training requirements imposed on health care "navigators."
Other Texas Republicans have also slammed the program. Lt. Gov. David Dewhurst, forced into a runoff against a tea party candidate after a tight primary, released a TV ad that shows businessmen and women in suits engaged in a high school cafeteria food fight - a metaphor, according to the ad, for the program's glitch-filled rollout.
It's not clear whether the Perry mandates and the intense public criticism of the law have scared off many potential enrollees. But Hernandez believes "lack of information and misinformation are key barriers."
Brenda Sanders, 54, was one of about a half-dozen people who trickled into a recent enrollment event on Houston's north side. Sanders knew the deadline and where to find a plan. She tried to apply, and it appeared she didn't qualify for financial assistance. The $200 monthly premium offered was unaffordable on her income of barely $600 a month, the part-time home care provider said.
"I'm a little disappointed," Sanders said. "Even with Obamacare, it's supposed to be affordable, but for people like me, that are low, low income, it's still not affordable."
And that is another struggle for Texas. The state decided against expanding Medicaid, despite the offer of federal dollars to help cover the costs in the first few years, meaning more than 1 million of the uninsured who do not qualify for subsidies could be left without coverage.
In the meantime, Houston and other areas are zeroing in on crucial populations: younger people and Hispanics. Houston spent about $40,000 on a two-week radio ad buy in English and Spanish. Hernandez also advertised in fitness centers, hoping to reach Hispanic mothers, believed to be the health care decision makers in those families.
Martha Blaine, executive director of the Community Council of Greater Dallas, recently spent just under $10,000 to buy radio spots on seven different Spanish radio stations in North Texas. The spots ran for two weeks in the morning and afternoon drive times and midday to hit stay-at-home moms. One was aimed at young men.
"Their mom will be listening to the other station and tell them to go do it," Blaine said. "We figure we'll hit them with both sides with that one."
Rodriguez has seen and heard all this, but remains adamantly opposed. Sitting alongside her GED classmates at the presentation organized by the Association for the Advancement of Mexican Americans, they run through their expenses: food, clothes, diapers, baby formula, baby sitters.
Sitting next to her is Mayde Arroyo, 32, who makes less than $400 a month working weekends at the Children's Place clothing store. She relies largely on the $780 a month she gets in child support to raise her 11- and 10-year-old boys. Often, she says, she doesn't have the $25 co-pay to take her children to the doctor under the insurance plan they have through their father. She is desperate to also be insured but not optimistic about obtaining coverage.
"I'm not going to work just to pay my insurance," Arroyo says, concluding she can't afford more than $50 a month for a plan.
Rodriguez, meanwhile, looks through the pamphlet she received at the event. An hour later, she's considering at least filling out an application. But even $20 a month is a stretch, she says. Like the $4,000 hospital bill she will ignore, she also shrugs off a penalty imposed by the law on those who are eligible for marketplace coverage but remain uninsured.
"It will just come out of my taxes so it doesn't matter," she says. "And it's way less than what they will take out monthly, right?"
Plushnick-Masti can be followed on Twitter at HTTPS://TWITTER.COM/RAMITMASTIAP .
WASHINGTON (AP) -- Debate over a powerful new painkiller ratcheted up Thursday as the head of the Food and Drug Administration defended the drug's approval and a West Virginia Senator responded with a bill to force it off the market.
FDA Commissioner Dr. Margaret Hamburg told Senate lawmakers that the recently-launched Zohydro fills an "important and unique niche" for treating chronic pain. Her agency has been under fire for clearing the drug since December, amid concerns from lawmakers, addiction specialists and others that the drug will exacerbate the national epidemic of prescription drug abuse.
Zohydro is the first single-ingredient hydrocodone drug ever cleared for U.S. patients. Each extended-release pill contains up to five times more of the narcotic than previously available combination pills, such as Vicodin. Pharmacies began dispensing the drug earlier this week.
Hours after Hamburg's appearance on Capitol Hill, Senator Joe Manchin, D-W. Va., introduced a bill that would force the FDA to withdraw the drug and prohibit the approval of any similar medications that don't have tamper-resistant design features.
"I have tried reasoning with the FDA, and I've repeatedly requested the agency change its course on this dangerous drug," Manchin said in a statement. "Because of this painkiller's high potential for misuse and abuse, Zohydro poses a severely dangerous threat to our communities in West Virginia and across our country."
Representative Stephen Lynch, D-Mass., introduced similar legislation in the House of Representatives.
In a statement late Thursday, Hamburg said the FDA has not had a chance to review the legislation.
"However, I look forward to continuing to work with Congress on preserving access to medications for patients suffering from pain, while addressing a serious public health problem - the inappropriate use of opioids."
Hydrocodone is the most frequently abused prescription drug in the U.S., according to the Drug Enforcement Agency. The Centers for Disease Control and Prevention reported that hydrocodone and other prescription opiates accounted for more than 16,650 deaths in 2010, a fourfold increase from 1999.
The opiate class includes drugs that mimic the effect of the opium poppy, such as morphine, oxycodone and heroin. Doctors prescribe opiates to treat pain from injuries, surgery, cancer, arthritis and a variety of other ailments. The drugs can unleash intense feelings of euphoria and well-being, especially when quickly absorbed via injection or inhalation.
Before Zohydro's approval, hydrocodone was available only in combinations with other non-addictive pain relievers, such as acetaminophen.
Hamburg pointed out Thursday that acetaminophen has its own well-known safety risks, including potentially deadly liver damage when taken at high levels. Zohydro provides doctors and patients with a "single hydrocodone product without that associated liver toxicity risk," Hamburg said.
Chief among the criticisms leveled at the FDA is that regulators should have required Zohydro to be formulated in a way that would make it difficult for abusers to chew, crush or dissolve. Any of those approaches can quickly release a massive, heroin-like dose of the drug which can be fatal.
Hamburg cautioned that tamper-resistant formulations are still in the early stages of development. To date, the FDA has only approved one medication with such features, a tamper-resistant version of OxyContin in 2010.
"It doesn't do any good to label something as abuse deterrent if it isn't actually abuse deterrent, and right now, unfortunately, the technology is poor," Hamburg said.
NEW YORK (AP) -- Zach Galifianakis brought the ferns, and President Barack Obama opened a new avenue of presidential communication.
The president urged young people to sign up for the new health care plan through an appearance posted Tuesday on the comic website Funny or Die, bypassing the news media and even previous favorites like TV talk show titans Jimmy Fallon and David Letterman. Instead, he chose to be a guest on Galifianakis' "Between Two Ferns," the digital short with a laser focus on reaching people ages 18 to 34.
The video reached 1 million views within three and a half hours of posting and was adding more at a pace of 1 million per hour in the middle of the day, according to Funny or Die. The website was briefly the number one source of referrals to Healthcare.gov, the Obama administration said, with some 19,000 people navigating directly from the video to the health care website in the first few hours.
"Gone are the days when your broadcasts - or yours or yours - can reach everybody that we need to reach," Obama press secretary Jay Carney said to broadcast journalists at the White House press briefing Tuesday.
With 4 million viewers, Obama exceeded in six hours the typical audience he would get by appearing on television shows hosted by Letterman, Fallon, Jimmy Kimmel, Seth Meyers, Jon Stewart or Stephen Colbert. That doesn't count the ancillary views - clips of the interview aired repeatedly on CNN. And the video was a topic on Howard Stern's radio show. By nighttime, the video had more than 8 million viewers.
As hip as Fallon and Kimmel may be in some circles, their audiences skew older - a median age of 52.7 for Fallon and 56.2 for Kimmel during the last week of February, the Nielsen company said.
For Web entertainment, it's a moment that rivals Emmy or Golden Globe nominations for Netflix's "House of Cards." And in presidential annals, it breaks form much like Richard Nixon did with his awkward jokes on television's "Rowan & Martin's Laugh-In."
In the clip, Galifianakis peppered Obama with awkward questions, including whether he'd locate his presidential library in Hawaii or Kenya.
"What's it like to be the last black president?" he asked.
"Seriously?" Obama said. "What's it like for this to be the last time you ever talk to a president?"
Galifianakis feigned annoyance when Obama, about halfway through the 6-minute clip, began urging young people to sign up for health care, sighing heavily before muttering, "Here we go."
"I think it's fair to say I wouldn't be here today if I didn't have something to plug," Obama said. As he went on, the "Hangover" star asked: "Is this what they mean by drones?"
Funny or Die was launched by Will Ferrell and partners in 2007 and has gone beyond being a niche location. There have been about 20 "Between Two Ferns" episodes, drawing an average of 6 million viewers each, and the Obama appearance is expected to go well beyond that number. Funny or Die gets 19 million unique visitors a month and has 7.8 million followers on Twitter and 5.5 million likes on Facebook.
Television talk show appearances have since become an accepted part of the political circuit. The Obama administration hasn't ignored this: First lady Michelle Obama appeared on a skit last month in Fallon's first week at "Tonight." Vice President Joe Biden was on Meyers' first show. The president played along with Fallon's "slow jam the news" skit in talking about student loans in 2012, when he was running for re-election.
He's done interactive Web appearances with Linked In, Google and Twitter, said presidential spokesman Joshua Earnest. But it wasn't quite like Galifianakis questioning him about whether there's another presidential pardon for a turkey in order or showing him a rash on his arm.
"The video enabled the president to deliver his message very clearly but in a way that's fresh and appealing to a young audience," said Susan Etlinger, an Internet analyst for the Altimeter Group. "It's almost cynical but in a sincere way."
The White House began talking with Funny or Die last summer about ways to promote the health care plan, and the site has posted several comic videos about the topic, said Mike Farah, production president of the site and executive producer of "Between Two Ferns." The interview was taped two weeks ago.
"What I really love about the video is that it's a funny `Between Two Ferns' first," Farah said. At the end, the interview's black backdrop collapses and it's revealed the White House is where the appearance was taped - the joke being that's where Galifianakis does all his shows.
In the first few hours, 96 percent of the site's visitors judged the video funny, meaning it had reached immortal status on the site, he said.
As 2016 approaches, no doubt other politicians will be watching its impact.
Not everyone was amused, though. On Fox News Channel's "Fox & Friends," host Brian Kilmeade said the video was inappropriate and "pretty tragic."
Carney was asked whether some presidential dignity was compromised.
"We obviously assess opportunities that we have and, you know, look at whether they're going to be successful and wise," he said. "And I think we made the right call here."
Associated Press writer Nedra Pickler at the White House contributed to this report.
TAHIRPUR, India (AP) -- At first, Ashok Yadav ignored the patches of pink skin on his arm. But when pale sores erupted on his body and he lost sensation in his fingertips, a doctor issued the devastating diagnosis: Yadav had leprosy.
"What followed was like a nightmare," said Yadav, who has lived in Kasturba Gram, a leper colony outside New Delhi, since his diagnosis 30 years ago. "I lost my job. My parents felt I would spoil my sisters' chances of getting married. My family felt it would be better if I left home."
The stigma of leprosy endures in India, even though the country has made great strides against the disease, which is neither highly contagious nor fatal. Now the number of new annual cases has risen slightly after years of steady decline, and medical experts say the enormous fear surrounding leprosy is hindering efforts to finally eliminate it.
People continue to hide their diagnoses from families and loved ones out of fear they will be ostracized. Employers regularly turn away people who have had the disease, even if they've been treated and cured. Many struggle to get driver's licenses and other routine documents. Even the disease-free children of leprosy patients are shunned.
"We face a thousand indignities every day," said Neelawati Devi, a longtime resident of Kasturba Gram. Some 10,000 people live there, including the children of leprosy patients.
"Our children face taunts and slights when they go to school," said Devi, holding out her hands, the stubs of her fingers wrapped in gauze bandages. "But we want them to get an education and get jobs. Their future should not be ruined."
Public health centers across the country have launched campaigns describing leprosy as the world's "least contagious communicable disease." Health workers are trying to spread the word that leprosy is not hereditary and does not spread through normal contact.
But the deformities that are the hallmark of leprosy contribute to the fear surrounding the disease, a chronic bacterial infection that often lies dormant for years before attacking the body's nerves and slowly causing numbness. Hands and feet eventually claw inward and serious injuries often go unnoticed because no pain is felt. Often fingers and toes are lost due to injuries and sores. Scientists believe it is spread through droplets from coughing or sneezing during prolonged contact with someone infected, but they are still not completely sure.
Also called Hansen's disease, leprosy has been curable since the 1940s thanks to antibiotics, and the worst physical deformities can be avoided if it is caught in time. About 95 percent of people have a natural immunity.
Worldwide, the number of new leprosy patients dropped from around 10 million in 1991 to around 230,000 last year as countries intensified efforts to fight the disease. In India, hospitals and clinics began treating patients with a combination of drugs that effectively kills mycobacterium leprae, the germ that causes leprosy.
In 2005, India declared victory, with health authorities reporting less than one case for every 10,000 people. But pockets of the country continue to have problems with leprosy, including in the central state of Chattisgarh, Maharashtra in western India and Bihar and West Bengal in the east.
According to the health ministry, during 2012-2013 India detected 134,752 new cases of leprosy, slightly more than the 127,295 cases reported a year earlier. India accounts for 58 percent of newly diagnosed leprosy cases in the world, according to the World Health Organization. The disease also remains a problem in Brazil, China, Indonesia and East Timor.
C.M. Agarwal, the health ministry official in charge of the country's leprosy campaign, says the rise in cases is the result of an intensified campaign against leprosy, meaning health workers are reporting cases that otherwise would have gone unnoticed.
But some activists disagree. They say that after India's 2005 declaration, the leprosy program was merged with the country's public health scheme and scarce resources were reassigned for other urgent causes.
They also say the problem might be worse than anyone realizes because of leprosy's long gestation period.
"The incubation period can stretch from five years to 15 before the first signs become detectable. And by then, many others could become infected," said P.K. Gopal of the National Forum of Persons Affected by Leprosy, a nongovernmental organization working with leprosy patients.
The government is stepping up its fight against the disease, assigning additional health workers to 209 districts seen as high endemic areas in 16 states. But that won't end the pain and stigma that leprosy brings to patients and their families.
"Our children shouldn't have the shadow of leprosy hanging over their lives," said G. Venugopal, one of the elders at Kasturba Gram, as he sat outside his home under Delhi's weak winter sun.
"They often face taunts in school. People are cruel. They will say: `Oh, this is the son of a leper.' Then the children say they don't want to go to school and we have to push them," he said.
Gopal, who has worked with leprosy patients for more than 40 years, said the stigma persists "because it's very difficult to change people's attitude over a short period of time."
"As things are, the fear of leprosy is so great that people refuse to come forward for treatment. This has had an adverse effect on the success of the leprosy program," he said.
Venugopal has been working with non-governmental agencies to lobby the government to expand the disability allowances that some leprosy survivors get. "They pay us a monthly allowance of 1,800 rupees ($29), which is a pittance," he said.
The money does not even pay for the bandages that leprosy patients use every day on their sores, said Uttam Kumar, another resident.
Like many others in Kasturba Gram, Kumar was thrown out of his home because neighbors objected to having a leprosy patient in their midst. Kumar, whose bandaged feet are the only sign of his ailment, spent months on the road before finding a refuge in the warren of one-room tenements in Kasturba Gram.
"Here we are all anonymous yet we are all fellow sufferers," Kumar said. "Everyone has their own sorrows, but our pain is the same."