A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

Scialfa shared the news in “Road Diary: Bruce Springsteen and the E Street Band,” which premiered at the Toronto Film Festival on Sunday, Sept. 8, according to Variety.

“This affects my immune system, so I have to be careful what I choose to do and where I choose to go,” the 71-year-old said in the film. “Every once in a while, I come to a show or two, and I can sing a few songs on stage, and that’s been a treat. That’s the new normal for me right now, and I’m OK with that.”

Variety reported Scialfa didn’t attend the premiere for the documentary. The current state of her health and whether she is receiving treatment for her myeloma is unclear.  

E Street Band was founded in 1972, nearly two decades before Springsteen and Scialfa married in 1991. In 2014, she, along with the rest of E Street Band, was inducted into the Rock & Roll Hall of Fame.

What is multiple myeloma?

The cancer Scialfa was diagnosed with, multiple myeloma, creates cancerous plasma cells in the bone marrow, which prevent the body from producing antibodies and reducing the ability to fight off infection, per Mayo Clinic. It’s not clear what causes it and there’s no cure.

Not everyone with multiple myeloma receives treatment. In some cases, if the cancer is not progressing and not causing symptoms, doctors may opt for a wait-and-see approach. It’s not clear if Scialfa needed or still needs treatment for her myeloma.

Symptoms of multiple myeloma include:

• Bone pain, especially in the hips, spine or chest
• Digestive issues, such as nausea, constipation and loss of appetite
• Mental issues, such as tiredness and brain fog
• Infections
• Weight loss
• Weakness
• Thirst and needing to pee more than usual

The cancer is more common in people in their late 60s, as well as men, Black people and those with a family history of multiple myeloma. Treatments, if needed, include immunotherapy, CAR-T cell therapy, chemotherapy, bone marrow transplant, radiation and more.

Between 42% and 82% of people diagnosed with multiple myeloma survive for four years or more, according to Cleveland Clinic.

Bruce Springsteen’s health issues

Scialfa isn’t the only band member who’s had to deal with illness. In 2023, Springsteen revealed health issues of his own. The “Born to Run” singer announced via X that he and the E Street Band would be postponing their shows because Springsteen had a peptic ulcer.

In 2024, he announced via Instagram that he’d be postponing additional concert dates until the following year on doctor’s orders due to “vocal issues,” TODAY.com reported at the time.

A few months later, Springsteen shared additional details about the ordeal with SiriusXM’s E Street Radio. “When I had the stomach problem, one of the big problems was that I couldn’t sing,” Springsteen said. “You sing with your diaphragm. My diaphragm was hurting so badly that when I went to make the effort to sing, it was killing me. So, I literally couldn’t sing at all.”

Springsteen’s also gotten candid about his mental and physical health. In 2012, Springsteen told The New Yorker that he’d dealt with “intervals of depression.” Scialfa added that therapy has helped him.

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

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But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn’t find a heartbeat. The unborn baby boy had already died in the womb. 

Soon after, the mother’s syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.

It’s a death, Stafford said, that could’ve been prevented with early detection and a shot of penicillin. 

Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. at the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.

Syphilis in the U.S.

More than 200,000 cases were reported in 2022, the most since 1950.

The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the “great imitator” because its symptoms can vary so widely. Most people don’t show symptoms or know they’re infected, and even if they do visit the doctor’s office, there’s no guarantee they’ll be properly diagnosed.

Stafford said her patient didn’t have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn’t think too much about it, Stafford added.

“There’s a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they’re not necessarily getting a sexual history,” said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that “the issue is tests not being done in the first place.”

The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.

“The solutions for controlling syphilis are relatively straightforward. We’re not talking about high tech approaches or a novel therapeutic,” said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. “It simply revolves around closing gaps in testing and treatment.”

As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease. 

Most often, that comes down to figuring out how to get people tested, a task that’s far easier said than done.

Spreading the word about syphilis

Given these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers. 

A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex. 

So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, “Paying for Sex? Get Tested!”

“We had to go bold, and we had to get to the point,” she said. The pushback was inevitable — “you might have to say something to your 10-year-old who can read,” Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.

Of course, syphilis doesn’t just spread among sex workers, so last year, Fox’s team broadened the campaign, keeping the same look and feel but instead saying “Syphilis is Serious” with “Spreading Locally!” overlaid over the side.

Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words “Eye Syphilis is Serious” and a black silhouette of a pregnant woman with a red belly saying “Syphilis Can Be Fatal to Your Baby.” While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or “loss frame,” draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.

“We’re not telling anybody not to have sex,” Fox said. “We’re telling people to have safe sex,” and to get tested afterward.

The sex positivity message isn’t just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard “pee in a cup” test can’t detect syphilis.

“Many physicians haven’t seen syphilis, and they’ve got a million things to know,” Fox said. “If we don’t talk to the physicians, we’re not going to get the testing we need done.”

Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth’s electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.

Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former “setting the parameters of what standard of care should look like” and hospitals making it a reality. 

Make syphilis testing convenient

Beyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said. 

Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people. 

As such, tribes across the U.S. have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.

“We’re just helping people pay for gas and child care and get food on their table,” Leston said. At Cass Lake Indian Hospital’s pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.

In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.

Even with these programs, syphilis testing can be overshadowed by more immediate concerns.

In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state’s rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal,
a supervising public health nurse in the county’s STI unit.

In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county’s most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there’s no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.

Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county’s public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.

Piggybacking syphilis services

Shasta County’s mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn’t have considered STI testing, if not for the package deal.

This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. “It might be more costly, but it’s also much, much more effective and helpful to the community,” Seña said.

Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.

“We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don’t get tested,” Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well. 

Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.

“You can’t just rely on public health departments to do the brunt of the work for STI recognition and prevention,” she said. “You have to go hand in hand with other providers in the community.”

The future ahead

The U.S. got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America. 

“What changed behavior then was lethal, hard-to-treat disease,” said Mayer, from Fenway Health. “Now, you have a generation of people who may be less informed,” leading to lower rates of condom use and STI screening rates. 

However, it’s also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that’s probably several years down the line.

“Our task right now is to arrest the growth in cases,” said Chokshi, from the Common Health Coalition, and he’s optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.

“There’s no reason that the endgame can’t be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable,” Chokshi said.

This article first appeared on NBCNews.com. Read more from NBC News here:

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A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

This is the 14th person in the U.S. sickened with bird flu since March, when the virus was detected in cows, after infecting wild birds and mammals worldwide. One other person was infected in 2022.

The risk to the general public remains low, U.S. Centers for Disease Control and Prevention officials said in a statement. No unusual flu activity has been detected in the U.S., including in Missouri, officials said.

The latest case was confirmed after the person, an adult, was hospitalized on Aug. 22 with other medical conditions, officials with the Missouri Department of Health and Senior Services said in a statement.

The person tested positive for influenza A, and CDC officials later confirmed it to be bird flu. The person received antiviral medication and has since recovered and gone home, health officials said. It’s not clear whether the hospitalization was caused by the bird flu infection or the person’s existing health conditions, said Lisa Cox, a spokesperson for the Missouri health department.

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Health officials didn’t release the person’s name, age or hometown. No close contacts of the person have been infected, CDC officials said.

The case raises questions about how the person was exposed to the virus. All the previous U.S. infections were among people who worked around cows and poultry.

Bird flu has been detected in nearly 200 dairy herds in 14 states, but not in Missouri, according to the Agriculture Department. Bird flu has also been found in commercial and backyard flocks and in wild birds. The person did not report drinking raw milk, which can contain live virus, Cox said.

The investigation is continuing, officials said.

It’s the first case detected through routine influenza surveillance rather than through targeted efforts to identify people infected with bird flu through exposure to infected cows and poultry, officials said.

___

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

This summer, we saw a surge in Covid cases, that started in early June. And health experts predict that flu season could start early this year, too.

“For everyone aged six months and above, the recommendation is to get both a Covid and a flu booster,” Dr. Jen Brull, president-elect of the American Academy of Family Physicians, tells CNBC Make It.

The “flu [shot] is widely available. Covid was approved, is being released and is available in some places now. [It] should be widely available within the next few weeks to everyone.”

RSV (respiratory syncytial virus) season typically starts in October, and certain groups are more susceptible to severe outcomes from the virus than others, making its vaccine vital to receive.

Here are the vaccines that Brull recommends getting this fall season, and when it’s best to get them.

Here’s what you need to know about vaccines for fall and winter, from a doctor

1. The newest Covid vaccine

“Every year there is a new strain that’s going to cause grief, and the CDC is watching for that, and the FDA is watching for that, and the people who develop that updated [vaccine] are watching for that,” Brull says.

“And they are targeting the strain that is most likely to be prevalent and dangerous, just like we do for influenza.”

The new Covid vaccine will target the Omicron variant, KP.2, Brull tells Make It. The variants that are spreading the most in the U.S. at the moment are similar to KP.2, The New York Times reported.

When should you get the updated Covid vaccine? Brull suggests getting the vaccine as soon as it is available to you. “It is also okay, especially if you are at higher risk, or if you’ve had Covid in the last couple of months, or if you got a late summer booster of the last Covid vaccine because perhaps you’re at increased risk, to wait just a little bit longer into the fall.”

How much will it cost? Insurance plans typically cover the Covid vaccine, and you can usually receive it for free, Brull says. However, people who are uninsured could pay as much as $200 for the updated Covid vaccine this fall, according to The Washington Post. There may be programs available through a local health department or public health department where those who are uninsured can get the vaccines for little to no cost, Brull notes.

2. The updated flu shot

This one may come as no surprise, as the annual flu shot has been recommended for everyone above the age of six months for decades.

Some groups are at a higher-risk of severe complications from the flu, according to the CDC, including:

• People over the age of 65
• Children younger than five years old, especially those under the age of two
• Pregnant people
• Those with certain medical conditions, including diabetes, heart disease and asthma

“But even for people with none of those risk factors, you can end up quite ill with influenza, and there’s really no rhyme or reason who ends up in the ICU versus who has a mild case,” Dr. Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah, told Make It last year.

When should you get the newest flu shot? Last year, Pavia told Make It, “you’re fine to get your vaccine in early September, [but] waiting until October may give you a little more protection against the late flu season.” Brull suggests getting your flu shot at the same time that you receive your Covid vaccine because “there may be a slight boost to your immunity if you get more than one vaccine at a time,” and you won’t forget to get the vaccines as you might have if you decided to delay receiving them.

How much will it cost? With an insurance plan, you can usually access the flu vaccine for free, Brull says. “For adults who are uninsured, oftentimes, health departments will carry vaccines for adults at low or no cost,” she adds.

3. The RSV vaccine

Unlike the Covid and flu shots, the RSV vaccine is mainly administered to infants and adults ages 60 and older who are at a higher risk of severe outcomes from the condition.

“Everyone can get RSV, but usually the people who become most ill are the young and the old,” Brull says.

Infants younger than 8 months old should receive the RSV vaccine if they’re born during this RSV season, which typically begins in October and ends in March, or are entering their first RSV season, according to the CDC.

The newest updates on the recommendations for adults who should receive the new RSV vaccine are:

• Anyone aged 75 and older should get the vaccine.
• Those between the ages of 60 and 74, should receive the RSV vaccine only if they have certain chronic medical conditions like heart disease or lung disease, or are living in nursing homes.

“This recommendation is for adults who did not get an RSV vaccine last year. The RSV vaccine is not currently an annual vaccine, meaning people do not need to get a dose every RSV season,” according to the CDC.

When should you get the RSV vaccine? At-risk groups should receive the RSV vaccine as soon as it becomes available, Pavia told Make It last year.

How much will it cost? Coverage for the RSV vaccine is variable, Pavia said. With certain Medicare plans, the RSV vaccine is fully covered. But if you don’t have insurance coverage, you could pay a hefty price to receive the shot, Pavia said.

“Private insurance could cover it, but they’re not legally required to do it for 12 months. So your insurance company might or might not cover it,” Pavia told Make It.

Want to master your money this fall? Sign up for CNBC’s new online course. We’ll teach you practical strategies to hack your budget, reduce your debt, and grow your wealth. Start today to feel more confident and successful. Use code EARLYBIRD for an introductory discount of 30% off, now extended through September 30, 2024, for the back-to-school season.

Plus, sign up for CNBC Make It’s newsletter to get tips and tricks for success at work, with money and in life.

An AP analysis of Food and Drug Administration data shows that agency staffers have not returned to roughly 2,000 pharmaceutical manufacturing firms to conduct surveillance inspections since before the pandemic, raising the risks of contamination and other issues in drugs used by millions of Americans.

The firms that are overdue for safety and quality inspections represent about 42% of the 4,700 plants that are currently registered to produce drugs for the U.S. and previously underwent FDA review before May 2019, the AP found. The plants make hundreds of critical medicines, including antibiotics, blood thinners and cancer therapies.

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Under FDA’s own guidelines, factories that haven’t been inspected in five or more years are considered a significant risk and are supposed to be prioritized for “mandatory” inspections. Most of the overdue plants are in the U.S., but more than 340 are in India and China, countries that together make up the largest source of drug ingredients used in low-cost U.S. prescriptions.

“Generic drugmakers are under intense pressure to cut their costs and some will do that by cutting quality,” said David Ridley of Duke University, who studies the pharmaceutical industry. “If they’re not inspected, then we won’t know about it until — in a few tragic cases — it’s too late.”

Tainted eyedrops from an Indian factory led to an outbreak of antibiotic-resistant bacteria that sickened more than 80 Americans last year. Four people died and more than a dozen others were blinded. The plant never registered with the FDA.

Prior to COVID-19, dozens of common medications made at FDA-regulated plants were recalled due to traces of cancer-causing contaminants. The FDA didn’t open its first overseas outposts until 2008, after dozens of U.S. deaths were linked to a contaminated blood thinner imported from a Chinese plant that hadn’t been inspected.

“The U.S. drug supply is the safest on the planet and no other regulator conducts more inspections than the FDA,” said FDA Associate Commissioner Michael Rogers, noting that the agency has increased drug inspections each year since 2021 while prioritizing foreign factories.

But last year’s inspection numbers were still down almost 40% from the pre-pandemic period, when the FDA averaged around 4,300 annual inspections. Rogers offered no date for when the backlog of uninspected plants might be cleared.

The agency’s work has been hampered by a wave of staff departures, he said, including longtime inspectors who have found new jobs that often allow them to work from home.

“There’s a significant cost to the agency associated with the loss through attrition of an experienced investigator," Rogers said. "We need to retain these people, and we are.”

The FDA halted all but the most “mission critical” inspections in March 2020. It gradually restarted prioritized inspections later that year, but regular international visits did not resume until 2022.

In a statement, the FDA said that it receives inspection details from international partners, including European regulators, which help the agency decide whether a visit is necessary. The agency also began using video and other online tools to evaluate plants remotely during COVID-19, although those aren't equivalent to physical inspections.

The FDA’s struggles overseeing the global pharmaceutical supply have been documented by the Government Accountability Office, which has flagged the area as a “high risk” issue every year since 2009.

Beginning in the 1990s, drugmakers began shifting manufacturing overseas, first to Puerto Rico, and then to Asia in search of cheaper labor and materials. The FDA has largely been playing catch-up ever since.

“We have to recognize that this is the world we live in and we have to adapt to it,” said Dr. Stephen Ostroff, FDA’s former chief scientist. “That has to include being able to get into these facilities and take a look at what they’re doing, particularly in India and China.”

'Cascade of failure'

The FDA keeps a confidential list of drug facilities to inspect, prioritizing them based on potential risks.

The AP created its own list by compiling public records of FDA inspections from before COVID-19 and tracking which firms haven’t received a follow-up within five years. The data accounts for the vast majority of inspections, but has some omissions, including visits required for new drug approvals and those that are part of ongoing government investigations.

The AP's tally of overdue plants also doesn’t include any of the new facilities that have registered with the agency since COVID-19 but haven’t yet had an initial inspection. FDA’s internal list of sites for inspection has increased 14% over the past five years, the agency noted last year.

The FDA said in a statement that it “must be judicious and apply a risk-based approach,” due to the “enormity” of its workload and limited budget.

“We prioritize the inspections that pose the greatest risk to public health,” the agency said.

On a global basis, FDA says only 6% of sites inspected last year had serious problems. But rates are higher in India, where 11% of plants were cited for violations, the most of any country.

Nearly 90% of FDA’s foreign inspections in fiscal 2023 were announced in advance, according to FDA correspondence with Congress obtained via public records requests. The GAO and other government watchdogs have long raised concerns about the practice, which typically gives companies up to 12 weeks to correct or conceal potential problems.

Even with the advanced warnings, the FDA has found egregious violations in overseas factories.

When agency staffers visited Intas Pharmaceuticals’ plant in northwest India for the first time in nearly three years they found what they called a “cascade of failure.” Among the violations, inspectors saw an employee “pouring acetic acid in a trash bin” to destroy company documents used for drug testing. Elsewhere inspectors found “plastic bags filled with torn and discarded” documents relating to quality control measures.

“This kind of behavior has been pointed out to the FDA time and time again by people like me for the last 10 years,” said Dinesh Thakur, a former pharmaceutical industry executive who became a whistleblower for the U.S. government. In 2013, his work led to a $500 million settlement with Indian drugmaker Ranbaxy for falsifying generic drug data.

“If you do not prosecute people who do this kind of wrongdoing, it gives the implicit signal that the FDA will give companies a pass,” Thakur said.

In the case of Intas, FDA issued a warning letter — which has no legal repercussions — and blocked some of the company’s exports to the U.S., while attempting to maintain shipments of the critical chemotherapy drug cisplatin. That strategy backfired in June 2023 when Intas abruptly shuttered the plant, triggering a nationwide shortage of cisplatin, which is used in more than a half-dozen cancers.

FDA inspections in India have been accelerating, but 160 plants are overdue, including some which haven’t been inspected since 2015 yet continue shipping pain pills, antibiotics and other medications to the U.S., according to AP's analysis.

Mexico, France and Spain also have over 100 overdue firms between them.

In China, political tensions have made inspections even more challenging. Just two fulltime FDA inspectors are based in the country, where about 185 factories are overdue. Former FDA officials say the Chinese government has withheld visas from inspectors unless the U.S. reciprocates for Chinese nationals seeking to enter the U.S.

FDA Commissioner Robert Califf has acknowledged his discomfort with the current situation.

“Even if we do periodic inspections, it’s not the same as a society where you have more freedom of information,” Califf told lawmakers at a hearing last year. “I am very concerned about it.”

Help wanted

The FDA could seemingly address its inspection backlog by hiring more investigators or assigning extra work to current staffers. But the agency is struggling to hold onto inspectors who can often earn far more working for the companies they now regulate.

On a call with FDA stakeholders in May, Rogers warned that “our attrition rates and our inability to retain our staff” would soon impact the agency’s ability to oversee drugs and other medical supplies.

The FDA currently has 225 vacancies on its inspection workforce, nearly four times as many as before COVID-19, according to agency records.

New inspectors generally start at an annual salary of about $40,000 and can eventually rise to over $100,000. Job postings alert applicants they may have to travel “up to 50% of the time.”

In 30 years as an FDA inspector, Jose Hernandez experienced firsthand the grueling pace and pressures of the job.

When he began doing international inspections in the mid-1990s, it was on a volunteer basis and employees spent no more than six weeks per year outside the U.S. By the end of his government career, Hernandez was traveling overseas more than four months per year, making multiple trips to Asia.

For each one-week inspection, he said he might need another week or more to write up his report, particularly if he found serious violations. Hernandez says that extra time and attention to detail wasn’t always appreciated by his managers.

“They just wanted people who are like bean counters: walk in, walk out and find nothing so that they can get this report through the system and make their numbers,” he said.

Hernandez retired from the FDA in 2014, earning just over $100,000 in his final year. Today he is a private consultant and says former FDA inspectors can easily earn more than $250,000 working for industry.

“Now I fly business class, I stay in nice hotels, I rest when I get there and nobody tells me what to do,” Hernandez said. “I made the right decision.”

FDA says it's exploring ways to make the jobs more attractive, including extra pay for experienced staffers and offering more flexible, comfortable travel arrangements.

Testing for quality

The slowdown in inspections has attracted scrutiny from lawmakers and raised new questions about whether FDA’s decades-old approach is working.

House Republicans have peppered the agency with dozens of inquiries about the program since 2023. In their most recent letter, members of the Energy and Commerce Committee ask regulators to explain why FDA staffers making high-priority inspections in Asia are reporting less than half as many violations today compared with pre-COVID-19.

“The committee is concerned that FDA’s fear of triggering additional drug shortages is driving the decreased rate that FDA issues warning letters,” states the June letter.

FDA’s Rogers rejected the argument, saying inspectors follow strict guidelines when conducting inspections and that decisions about managing drug shortages are handled separately by other parts of the agency.

A pilot program requested by the U.S. Defense Department takes an alternative approach to monitoring the drug supply. The Pentagon is collaborating with a private laboratory, Valisure, to evaluate 40 prescription drugs critical to military personnel, testing them for contaminants, dosing and other issues. Initial findings from the two-year program found serious flaws in about 10% of a subset of drugs tested, according to results shared with the AP.

Laboratory testing of imported drugs has long been standard practice in Europe, where more than 70 private labs operate alongside government regulators.

The testing approach has attracted interest from experts concerned that FDA’s method — rooted in physical inspections and reviewing paperwork — may not be up to the task of uncovering manufacturing problems on the other side of the world.

Stanford University Dr. Kevin Schulman believes in incentivizing U.S. pharmacy chains and drug distributors to only purchase drugs from high-quality manufacturers.

Currently, U.S. companies decide which generic drugs to buy based on whichever company has the lowest price, Schulman said. “Purchasers say, ‘Well, it’s the FDA’s job to worry about quality, not ours,’" he said.

Even as the FDA struggles to recover from COVID-19 and reinspect plants worldwide, Schulman sees a potential upside.

“Maybe this is the straw that breaks the camel’s back,” he said. “That, in fact, we should just admit that one U.S. agency can’t regulate the entire global manufacturing for this critically important market.”

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The latest survey numbers show the teen vaping rate fell to under 6% this year, down from 7.7% in 2023. More than 1.6 million students reported vaping in the previous month — about one-third the number in 2019, when underage vaping peaked with the use of discrete, high-nicotine e-cigarettes like Juul.

This year’s decline was mainly driven by a half-million fewer high school students who reported using e-cigarettes in the past month, officials said. Vaping was unchanged among middle schoolers, but remains less common in that group, at 3.5% of students.

“This is a monumental public health win,” FDA’s tobacco director Brian King told reporters. “But we can’t rest on our laurels. There’s clearly more work to do to further reduce youth use.”

King and other officials noted that the drop in vaping didn’t coincide with a rise in other tobacco industry products, such as nicotine pouches.

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Sales of small, flavored pouches like Zyn have surged among adults. The subject of viral videos on social media platforms, the pouches come in flavors like mint and cinnamon and slowly release nicotine when placed along the gumline. This year’s U.S. survey shows 1.8% of teens are using them, largely unchanged from last year.

“Our guard is up,” King said. “We’re aware of the reported growing sales trends and we’re closely monitoring the evolving tobacco product landscape.”

The federal survey involved more than 29,000 students in grades 6 through 12 who filled out an online questionnaire in the spring. Health officials consider the survey to be their best measure of youth tobacco and nicotine trends. Thursday’s update focused on vaping products and nicotine pouches, but the full publication will eventually include rates of cigarette and cigar smoking, which have also hit historic lows in recent years.

Officials from the FDA and Centers for Disease Control and Prevention attributed the big drop in vaping to recent age restrictions and more aggressive enforcement against retailers and manufacturers, including Chinese vaping companies who have sold their e-cigarettes illegally in the U.S. for years.

Use of the most popular e-cigarette among teens, Elf Bar, fell 36% in the wake of FDA warning letters to stores and distributors selling the brightly colored vapes, which come in flavors like watermelon ice and peach mango. The brand is part of a wave of cheap, disposable e-cigarettes from China that have taken over a large portion of the U.S. vaping market. The FDA has tried to block such imports, although Elf Bar and other brands have tried to find workarounds by changing their names, addresses and logos.

Teen use of major American e-cigarettes like Vuse and Juul remained significant, with about 12% of teens who vape reporting use of those those brands.

In 2020, FDA regulators banned fruit and candy flavors from reusable e-cigarettes like Juul, which are now only sold in menthol and tobacco. But the flavor restriction didn’t apply to disposable products, and companies like Elf Bar stepped in to fill the gap.

Other key findings in the report:

• Among students who current use e-cigarettes, about 26% said they vape daily.
• Nearly 90% of the students who vape used flavored products, with fruit flavors as the overwhelming favorite.
• Zyn is the most common nicotine pouch among teens who use the products.

Pharmacies began giving out the vaccines — which are recommended for everyone ages 6 months and older — last month. The Centers for Disease Control and Prevention recommends getting a flu shot either this month or next, since flu activity typically picks up in the fall, with cases reaching their peak sometime from December to February. 

It takes around two weeks for the vaccine to become fully effective. 

“You really want to think about getting your appointment or making your plan to get vaccinated sometime around the last half of September through the end of October,” said Dr. Judith O’Donnell, chief of infectious diseases at Penn Presbyterian Medical Center in Philadelphia.

This year’s flu shots are trivalent, meaning they protect against three flu viruses: two versions of influenza A and one type of influenza B. For more than a decade, flu shots in the U.S. also protected against a fourth strain of influenza B, but that strain hasn’t circulated since March 2020, so the Food and Drug Administration’s vaccine advisory committee elected this year to exclude it.

What to know about flu shots

Although most people need one dose of the vaccine, children up to 8 who haven’t been vaccinated for flu before should get two shots at least four weeks apart. The CDC recommends that unvaccinated children get their first shot right away.

Because adults ages 65 and up have the highest risk of severe illness from flu, they should ask for certain shots that produce a stronger immune response than a standard flu vaccine. The CDC recommends three options for this age group: Fluzone High-Dose, Flublok or Fluad. The first two are high-dose vaccines, meaning they contain a greater amount of antigen, an ingredient that triggers an immune response. Fluad, meanwhile, contains an ingredient that helps boost the immune response, called an adjuvant. 

“You have to really shop around and figure out where that’s available, because it won’t be available everywhere,” said Amanda Joy, a physician assistant at MedStar Health, a health care provider in the Washington, D.C., area. She suggested calling ahead to doctor’s offices or pharmacies.

Last year, around 25,000 people died of the flu in the U.S. and 400,000 were hospitalized.

The effectiveness of flu vaccines at preventing doctor’s visits tends to vary from year to year. Scientists choose which strains to target based on what’s circulating in other parts of the world, but it’s not a guarantee that those strains will dominate in the U.S.

“In an optimal year, you get up to about 80% [effectiveness]. In a bad year, maybe 30%,” said Dr. Michelle Barron, senior medical director of infection prevention and control at UCHealth.

Australia offers a window into what the U.S. can expect, since its flu season lasts from around June to September. This year, there weren’t an outsized number of hospitalizations or deaths.

“It looks like it was a fairly typical flu season. It didn’t necessarily start early, which was our concern last year,” Barron said.

Although some people with egg allergies may be hesitant to get flu vaccines, given that most are egg-based, the shots are still safe for that group. Joy said people with lingering concerns can seek out Flucelvax, a vaccine that’s developed using mammalian cells instead. 

Covid and flu shots can be administered at the same time

Health experts expect flu and Covid to deliver a one-two punch during the fall and winter, as they have in past years. Although the summer wave of Covid cases hasn’t died down yet, experts anticipate another wave this winter, perhaps at the same time that flu cases peak.

The new Covid vaccines target the KP.2 variant, which became dominant in the U.S. at the end of April. A genetically similar strain, KP.3.1.1, has since taken over, but the latest vaccine should still offer better protection against it than previous Covid shots.

The shots are recommended for everyone 6 months and older. Children up to 4 years old should get at least one dose of the new formula, and potentially two or three if they’ve never been vaccinated before, according to the CDC.

Everyone else should get one dose. People who recently had Covid can wait to get their shot until three months after their infection, since they’re likely to have some immunity already. 

The Covid and flu shots can be safely administered at the same time, in the same arm or different ones. The CDC recommends getting both at once for convenience, though it’s unclear if this brings additional advantages. A small study published in April found that co-administering Covid and flu shots boosted the antibody response to Covid in blood samples, but experts aren’t sure if that translates to more protection.

Getting the shots at once might also slightly increase side effects, according to a CDC study, though the reactions are still generally mild.

“You may feel some aches and some chills and maybe a low-grade temperature if you get them both together, but you could also get that from each individually,” Joy said.

She added that when finding a time to get any vaccine, it’s best to hold off if you’re feeling unwell.

“You may not get the full response you want if you’re getting vaccines while you’re sick, so it’s much better to wait ‘til you’re healthy,” she said.

How much do the shots cost?

Flu shots are available at doctor’s offices, pharmacies, health clinics and through some workplaces.

CVS and Walgreens have both Covid and flu vaccines in stock, but Walmart pharmacies only offer flu shots right now. Walmart said it’s prepared to administer Covid shots as supply becomes available. 

People with insurance shouldn’t have to pay out-of-pocket for the vaccines as long as they get them from an in-network provider. Covid and flu shots are also covered for children without insurance through the government-run Vaccines for Children Program. 

Adults without insurance may be able to find free or low-cost vaccines at some federally qualified health centers or state or local health departments, but supply can be limited. Otherwise, the Covid vaccine costs around $150 to $200 — a difference from past years, when they were free regardless of insurance status. The CDC’s Bridge Access Program, which paid for Covid shots for uninsured adults, ended in August.

Flu vaccines can range from $25 to more than $100, depending on the shot.

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The Food and Drug Administration released new standards in March of 2023 in an effort to help more women detect breast cancer sooner. The FDA gave providers until Sept. 9, 2024 to comply with the new rule for them to include a note on mammogram reports noting if their patients have dense breasts.

“It’s really an opportunity to put the power back into the hands of the patients and letting them know what type of density they have,” Molly Guthrie, with the Susan G. Komen Breast Cancer Foundation, told News4.

About half of women over the age of 40 in the U.S. have dense breast tissue, which can make cancers more difficult to spot on a mammogram, the FDA said. Dense breasts have also been identified as a risk factor for developing breast cancer.

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D.C. resident Cheryl Shaw beat breast cancer in 2008, but said she never imagined it would come back 11 years later.

“As a mom, as a grandma, I want to be around for them,” Shaw said. “You know, I have a lot more to do in life. I’m not done.”

When her cancer came back, doctors didn’t discover it until it was already in stage 3, even though she’d had a mammogram just months before.

It wasn’t detected because Shaw has dense breasts with a lot of tissue. But she said doctors hadn’t warned her about her breast density.

“If we don’t know what’s going on with our bodies, if we don’t know what the cause is or we don’t know what to look for, we don’t know what questions to ask,” she said.

Those with dense breasts may need to get MRIs or ultrasounds, depending on other risk factors.

According to the Centers for Disease Control and Prevention, breast density can change over time.

Women are more likely to have dense breasts if they’re younger, have a lower body weight, and are pregnant or breastfeeding.

Shaw is now in remission. She works at the Smith Center for Healing and the Arts on U Street, helping give back to cancer patients and spreading awareness on the importance of screenings.

“Some people see cancer as something they don’t want to know about, and that if they find out about it, they’re no longer gonna be here. But the reality is, there’s so many survivors and I’m one of them,” she said.

Black women are more than three times as likely to die from pregnancy or childbirth as white women in Oklahoma, which consistently ranks among the worst states in the nation for maternal mortality.

“Tulsa is suffering,” said Corrina Jackson, who heads up a local version of the federal Healthy Start program, coordinating needed care and helping women through their pregnancies. “We’re talking about lives here.”

Across the nation, programs at all levels of government — federal, state and local — have the same goals to reduce maternal mortality and erase the race gap. None has all the answers, but many are making headway in their communities and paving the way for other places.

Jackson’s project is one of more than 100 funded through Healthy Start, which gave out $105 million nationally in grants this year. Officials call Healthy Start an essential part of the Biden administration’s plan for addressing maternal health.

Other approaches to the crisis include California halving its maternal mortality rate through an organization that shares the best ways to treat common causes of maternal death and New York City expanding access to midwives and doulas two years ago. Several states passed laws this year aiming to improve maternal health, including a sweeping measure in Massachusetts. And last week, the U.S. Department of Health and Human Services announced more than $568 million in funding to improve maternal health through efforts such as home visiting services and better identifying and preventing pregnancy-related deaths.

Locally and nationally, “we need to really identify the birthing people who are at potentially the greatest risk,” New York City health commissioner Dr. Ashwin Vasan said, “and then wrap our arms around them throughout their pregnancies.”

A Healthy Start in Tulsa

Besides coordinating prenatal and postpartum care — which experts say is crucial for keeping moms alive — local Healthy Start projects provide pregnancy and parenting education and referrals to services for things like depression or domestic violence. The local efforts also involve women’s partners and kids up to 18 months. And they focus on issues that influence health, such as getting transportation to appointments.

“You try to get them in their first trimester and then work with them to delivery day, and then we also work with the babies to make sure that they reach their milestones,” Jackson said.

Jackson got help from the local Urban League as a single mom, and felt called to give back to her community. She’s been with Healthy Start for more than 25 years, first through Tulsa’s health department and recently through a nonprofit she started that received about $1 million in federal funds this fiscal year.

“I’m just like a mom to this program,” Jackson said.

Oklahoma overall has a maternal mortality rate of about 30 per 100,000 live births, significantly higher than the national average of about 23. But in Jackson’s quarter-century tenure, she said, there have been no maternal deaths among clients.

Pivotal to Healthy Start’s success are care coordinators like Krystal Keener, a social worker based at Oklahoma State University’s obstetrics and gynecology clinic, where clients get prenatal care. One of her responsibilities is to educate clients about health issues, like how to spot the signs of preeclampsia or how much bleeding is too much after delivery.

She also helps with practical matters: Many clients don’t have cars, so they call Keener when they need a ride to a prenatal visit, and she assists in scheduling one.

With doctors, Keener serves as a patient advocate. On a recent afternoon, Keener sat in on a prenatal appointment for Areana Coles. A single mom, Coles was joined by her 5-year-old daughter, who was born prematurely and spent time in intensive care.

Coles, 25, said Healthy Start is “probably the best thing that’s happened in this pregnancy.” She called Keener “an angel.”

Together they navigated several recent medical concerns, including dehydration and low potassium levels that put Coles in the hospital.

With Coles’ due date approaching, Keener talked about what to watch for around delivery and shortly after, like blood clots and postpartum depression. She advised Coles to take care of herself and “give yourself credit for small things you do.”

During an ultrasound a few minutes later, Coles watched Dr. Jacob Lenz point to her unborn baby’s eyes, mouth, hand and heart. He printed an image of the scan, which Coles immediately showed her daughter.

Keener said she’s gratified that Coles would not be giving birth prematurely this time.

“You made it to term – yay!” she told her client.

Coles smiled. “My body can do it!”

Improving medical care

While programs like Healthy Start focus on individual patient needs, other efforts manage the overall quality of medical care.

California has the lowest maternal mortality in the nation — 10.5 per 100,000 live births, less than half the national rate. But that wasn’t the case before it created a “maternal quality care collaborative” in 2006.

Founded at Stanford University’s medical school in partnership with the state, it brings together people from every hospital with a maternity unit to share best practices on how to deal with issues that could lead to maternal injury or death, like high blood pressure, cardiovascular disease and sepsis.

“When you look at the rate of maternal death in the United States compared to California, they basically ran neck-and-neck until it was established,” said Dr. Amanda Williams, clinical innovation adviser for the collaborative. “At that time they totally separated and California started going down. The rest of the country started going up.”

In the collaborative, hospitals get toolkits full of materials such as care guidelines in multiple formats, articles on best practices and slide sets that spell out what to do in medical emergencies, how to set up medical teams and what supplies to keep on the unit. The collaborative also tackles issues such as improving obstetric care by integrating midwives and doulas – whose services are covered by the state’s Medicaid program.

At first, some doctors resisted the effort, figuring they knew best, Williams said, but there’s much less pushback now that the collaborative has proven its value.

MemorialCare Miller Children’s & Women’s Hospital Long Beach started participating around 2010. The collaborative helps “vet through all the research that’s out there,” said Shari Kelly, executive director of perinatal services. “It’s just so important to really understand how we as health care providers can make a difference.”

For example, if a woman loses a certain amount of blood after a vaginal delivery, “we know to activate what we call here a ‘code crimson,’ which brings blood to the bedside,” Kelly said. “We can act fast and stop any potential hemorrhage.”

She said the collaborative has also helped reduce racial inequities — bringing down the rate of cesarean sections among Black moms, for example.

In July, U.S. Centers for Medicare & Medicaid Services proposed a similar initiative to California’s, focused on the quality of maternal care nationwide: the first baseline health and safety requirements for maternal emergency and obstetric services in hospitals.

A community perspective

Experts said getting maternal mortality under control at a national level requires tailoring solutions to individual communities, which is easier when programs are locally run.

New York City has a goal of reducing maternal mortality overall — and specifically achieving a 10% drop in Black maternal mortality by 2030. Statewide, Black residents are about four times more likely to die from pregnancy or childbirth than white residents.

The city is starting with, among others, low-income residents and those living in public housing. The New Family Home Visits Initiative gives pregnant people and those who’ve given birth visits from professionals such as nurses, midwives, doulas and lactation consultants. Vasan said more than 12,000 families have gotten visits since 2022.

Nurse Shinda Cover-Bowen works for the initiative’s Nurse Family Partnership, which has her visiting some families for 2 1/2 years, well beyond the pregnancy and birth. She said “that consistency of someone being there for you and listening to you and guiding you on your mother’s journey is priceless.”

Being grounded in the local community — and its history — is also crucial for Healthy Start projects. The lingering effects of racism are evident in Tulsa, where in 1921, white residents are estimated to have killed 100-300 Black people and destroyed homes, churches, schools and businesses in the Greenwood section. That’s where Jackson lives now, and where health disparities persist.

Being relatable is valuable for Black women, who may distrust the health care system, Jackson said. Plus, knowing the community makes it possible to work closely with other local agencies to meet people’s needs.

Denise Jones, who enrolled in Healthy Start in February, has struggled with anxiety, depression and drug addiction, but has been sober since April.

In mid-July, baby items filled her room — a crib, a bassinet, tiny clothes hanging neatly in a closet — in anticipation of her child’s arrival. Jones, 32, flipped through a baby book, pointing to a sonogram of her son Levi, who would be born within a couple of weeks.

She said she feels healthy and blessed by the help she’s gotten from Healthy Start and Madonna House, a transitional living program run by Catholic Charities of Eastern Oklahoma.

“I have professionals that are working with me and give me support. I didn’t have that with my other pregnancies,” she said. “I’m at one with my baby and I’m able to focus.”

___

Associated Press data journalist Nicky Forster in New York contributed to this report.

___

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

Each year, the Centers for Disease Control and Prevention looks to countries in the Southern Hemisphere as a potential indicator for what’s to come in the United States.

Some countries in South America and Africa experienced an earlier start to their flu seasons, which typically run from April to September and sometimes last until October or November, the CDC said in late August.

Influenza A, specifically H3N2 viruses, were predominant in Australia and South America, particularly in Chile, Ecuador and Uruguay, where there were high levels of severe flu-related disease and hospitalizations, the CDC said.

In Africa, influenza A H1N1 viruses dominated, though influenza B has increased in recent weeks, according to the CDC.

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The CDC said getting a flu vaccine is the best form of protection against severe illness and hospitalization.

A local doctor told News4 some people might want to get their shot as soon as possible as flu activity typically begins in America in October. It usually takes two weeks after a flu shot to build strong immunity.

“If you are in a high risk group, you know, 65 and older [or] you’re a pregnant person, then what you would want to do is get it as soon as possible so you can get that extra bit of protection as soon as you can. However, if you’re not in a high risk group, I would recommend waiting probably until the tail end of September or beginning of October. I think those are a great time so that you can get it to last all throughout the flu season,” said Dr. Adrian Dyer, a family medicine physician for MedStar Health.

It’s safe to get a flu shot and the new COVID-19 shot at the same time, according to the CDC. But Dyer said it’s alright to spread them out, if that’s what a patient prefers.

“You don’t have to do all the shots in one visit. You can space them out. Take one today. Take another one in two weeks. Take it slow,” Dyer said.

Children younger than 9 who have never had a flu shot before should get two doses this year, at least four weeks apart, according to the CDC. Kids in that same age group who have only had one shot during previous flu seasons may also need two shots this year.

In an interview with Australian Women’s Weekly, the 60-year-old explained why she opted against the standard treatment in favor of what she called a more “holistic” approach.

“It was a shock, it was unexpected, it was confusing, it was daunting in so many ways,” the Sports Illustrated swimsuit model said of the diagnosis in the interview published Monday. “And it really gave me an opportunity to dig deep in my inner sense to find a solution that worked for me.”

Macpherson, who has an upcoming book, “elle,” said it was difficult for her to take this nontraditional path.

“I chose an holistic approach. Saying no to standard medical solutions was the hardest thing I’ve ever done in my life. But saying no to my own inner sense would have been even harder,” she wrote, according to excerpts quoted by Australian Women’s Weekly.

“Sometimes an authentic choice from the heart makes no sense to others … but it doesn’t have to.”

She conceded this approach isn’t for everyone.

“People thought
I was crazy but I knew I had to make
a choice that truly resonated with
me,” Macpherson wrote. “To me, that meant addressing emotional as well as physical factors associated with breast cancer. It was time for deep, inner reflection. And that took courage.”

Macpherson’s two sons, Flynn, 19, and Cy, 14, disagreed over their mom’s choices.

“Cy simply thought that chemo kills you. And so he never wanted me to do it because he thought that was a kiss of death,” she wrote. “Flynn, being more conventional, wasn’t comfortable with my choice at all. He is my son, though, and would support me through anything and love me through my choices, even if he didn’t agree with them. My children were extremely supportive in their different ways but I knew they felt very scared.”

Her medical team consists of a naturopathy practitioner, a holistic dentist, an osteopath, a chiropractor and therapists, according to Australian Women’s Weekly.

She’s alive and well today.

“In traditional terms, they’d say I’m in clinical remission, but I would say I’m in utter wellness. And I am!” Macpherson said.

“Truly, from every perspective, every blood test, every scan, every imaging test … but also emotionally, spiritually and mentally — not only physically. It’s not only what your blood tests say, it’s how and why you are living your life on all levels.”

Macpherson has a history of publicly embracing unconventional and controversial approaches to medicine. She once dated disgraced British physician Andrew Wakefield and helped him promote his anti-vaccine movie, “1986: The Act.”

Wakefield is best known for making a discredited link between measles vaccines and autism, a disproven claim that made him a prominent figure in the anti-vaccine movement.

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Most states in the South and Southeast, including Florida, Georgia, Kentucky, Mississippi, Oklahoma, Texas, Virginia and the Carolinas, are facing heat warnings on this Labor Day, according to the National Weather Service.

Extreme heat can be dangerous for anyone, of any age. For many people living in those areas, relentlessly high temperatures can be especially dire.

In states such as Alabama, Georgia, Louisiana, Mississippi, Georgia and South Carolina, the rates of chronic diseases such as diabetes, heart disease and kidney disease are among the highest in the U.S.

Those diseases make it harder for bodies to cool themselves effectively during heat waves.

“People who have chronic health conditions are going to be more susceptible, particularly when you get sustained high-heat, high-humidity days,” said Dr. John Sherner, chair of medicine at MedStar Washington Hospital Center. “Their body is not going to be able to regulate temperature as tightly, so when the environment gets hotter, they’re going to get hotter more quickly.”

While no part of the U.S. is spared when it comes to rising heat or prevalence of underlying illnesses, the two often merge dangerously in the South and Southeast.

Monday’s heat risk forecast

“Major” and “extreme” heat risk levels pose a danger to people without effective cooling or hydration.

Under those conditions, the body’s natural impulse is to dilate, or widen, the blood vessels so that more blood gets to the skin to expel as much internal heat as possible. The heart has to work hard to make this happen.

It’s those Southern states that, historically, have had higher numbers of residents whose underlying health problems make it more difficult to do the work necessary to maintain a healthy body temperature.

Heart failure, for example, is a condition in which the heart isn’t able to pump oxygen-rich blood at full strength to the entire body, even in normal temperatures.

Heart failure hospitalization rates from 2019 to 2021

Among those 65 and older, Medicare beneficiaries in the eastern U.S. had the highest rates of hospitalization related to heart failure.

According to 2019-21 data from the Centers for Disease Control and Prevention, older adults on Medicare living in Southern and Eastern states had the highest rates of hospitalization for heart failure in the country.

Strains on hospital systems

“We’re seeing a lot of heart failure,” said Dr. Joanne Skaggs, associate chief medical officer of adults at OU Health University of Oklahoma Medical Center, said, as well as “a significant amount of patients who are dehydrated and feeling dizzy” in emergency departments.

The combination is creating “a lot of strain on an already strained” health care system, she said.

Patients with diabetes or other chronic disease are at even greater risk for heart failure, according to the CDC.

“I had a couple that literally cooked themselves,” said Dr. David Obert, University Medical Center of Southern Nevada in Las Vegas. The pair, both older adults, stayed in their house for three days after their air conditioner broke, and developed significant kidney failure.

‘A cycle we can’t seem to break’

Heat waves are increasingly longer and more intense each year.

2023 was the hottest year ever recorded, according to the National Oceanic and Atmospheric Administration, and there is a 77% chance that 2024 will break that record.

“Unfortunately, this is a cycle that we can’t seem to break,” said Kimberly McMahon, public program manager at NOAA’s National Weather Service.

This summer, the National Integrated Heat Health Information System developed a federal strategic plan designed to explore critical issues surrounding heat’s impact on health. McMahon is a co-chair.

“If we know that heat is deadly — and we’re actually very good at forecasting how hot it’s going to be — why do we continue to have so many deaths?” she said.

Staying safe in the heat

• Drink water. When you think you’ve had enough, drink more.
• Recognize the signs of heat-related illnesses, including cramping, muscle spasms, dizziness, headaches, weakness, nausea and confusion. Those are signals that a person may need medical attention.
• Seek help if you do not have access to air conditioning or other ways of cooling down.

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More often than not, disputing it can reveal errors and potentially lead to a more affordable bill, according to a study published Friday in JAMA Health Forum.

“If there’s a bill that you receive that doesn’t look quite right or that you can’t afford, pick up the phone and call the billing office,” said lead study author Erin Duffy, director of research training at the USC Schaeffer Center for Health Policy and Economics. “When people do, most get positive results.”

According to the survey’s results, about 1 in 5 people said they got a medical bill they disagreed with or couldn’t afford over the past year, 61.5% of whom said they contacted billing offices to address their concerns. Most people who didn’t call billing offices said they thought it wouldn’t make a difference, Duffy said. 

“Most of the time, the bill was corrected,” she said. “And even people who just felt it was unfair, even if they could afford it, a lot of them were able to negotiate a lower price.”

Among those who reached out about a billing error, almost three-quarters reported that the mistake was corrected, the study found. About 62% of people who reached out about an unaffordable bill said they got a payment plan or price drop; about 76% who wanted to negotiate said they got financial help or had their bill canceled.

The survey’s findings come as more than half of adults in the United States say they’ve had medical debt in the past five years, according to a 2022 survey from KFF, a nonprofit group that researches health policy issues. Another report from KFF finds that people in the U.S. owe at least $220 billion in medical debt. 

Dr. Adam Gaffney, a critical care physician at the Cambridge Health Alliance in Massachusetts, said medical debt can “ruin people’s financial futures,” including hurting their ability to get a loan or a mortgage. People have also had their wages garnished, he said, or have been sued by hospitals over unpaid medical bills.

Duffy notes that certain individuals in the survey were more inclined to dispute a medical bill: extroverts and people tend to be more skeptical, competitive and upfront about their opinions. 

People without a college degree, those with low financial literacy and the uninsured were the least likely to dispute a bill, she added. 

The study was based on survey responses from more than 1,100 adults in the U.S. between Aug. 14 and Oct. 14 of last year.

How to dispute a medical bill

The first thing you should do if something looks wrong on a medical bill is make sure the bill is yours, said Michele Johnson, executive director of the Tennessee Justice Center, a law firm and nonprofit advocacy group. That’s especially important if you have a common last name, she added.

“I’ve gotten bills before that aren’t even mine,” she said. “My husband’s name is Hill, my name is Johnson, and it’s happened repeatedly. So is it your bill? That’s the first thing to ask.”

Johnson also suggested asking the hospital for an itemized bill, which will provide a detailed list of all the services, treatments and procedures a patient got during the visit. Hospitals are required to send an itemized bill within 30 days of a request.

“We have seen situations where an infant baby boy is charged for a pregnancy test,” she said. “When they give you the itemized statement, look to see if those are services that you actually used or could have used.” And then call the billing office if something looks wrong. 

The No Surprises Act, which was signed into law in 2020, protects people from getting surprise medical bills when they get medical services from an out-of-network provider at an in-network facility, Johnson said. (In-network means the health care provider signed an agreement with your health insurance to accept a discounted rate; out-of-network means no agreement is in place.)

“If you’re in an insured hospital and see a doctor who is in-network for you, they can’t then have an anesthesiologist that is out-of-network,” Johnson said. 

People without insurance and those not using their insurance for a service can get a “good faith” estimate of the cost of care before their visit, she added. Then, if someone gets a bill that is at least $400 more than the estimate, they can dispute it. 

Many hospitals also offer financial assistance, also known as charity care, she said. Nonprofit hospitals are required to have a charity care policy and make it available to read on their website. If eligible, Johnson said, people can get the cost of their care reduced or even for free — even if they’ve already been billed. 

Johnson also advised against using credit cards to pay off a bill, if at all possible. That’s because a proposed rule from the Consumer Financial Protection Bureau that’s expected to take effect next year will remove medical debt from credit reports.

Johnson recommended requesting a payment plan instead. 

“Medical bills are treated differently than credit card debt,” she said. “You don’t want to pay that over the top of essentials like housing or food, which often our elderly clients will do even for bills they don’t actually owe.” 

Johnson said patients should remember that they can and should dispute a bill if they feel something is wrong.

“We think of health care bills as this whole other thing, like a black box that we don’t have any access to, because the American health care system is very much, there’s a power dynamic that really makes patients feel vulnerable and helpless,” she said. “But the truth is, if they’re charging you money, there are certain rules that protect you as a consumer and that enable you to push back.”

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The Food and Drug Administration authorized Novavax‘s updated protein-based Covid vaccine for emergency use in people ages 12 and up on Friday, paving the way for the shot to compete with Pfizer and Moderna‘s jabs this fall and winter. 

Novavax’s vaccine targets the highly contagious omicron subvariant JN.1, which began circulating widely in the U.S. earlier this year. JN.1 only accounted for 0.2% of cases circulating nationwide as of this week, according to the latest Centers for Disease Control and Prevention data. 

Novavax manufactures protein-based vaccines, which cannot be quickly updated to target another strain of the virus.

Despite that, the biotech company has noted that its shot provides protection against descendants of JN.1 that are currently dominant in the U.S., including KP.2.3, KP.3, KP.3.1.1 and LB.1.

“Our updated vaccine targets JN.1, the ‘parent strain’ of currently circulating variants, and has shown robust cross-reactivity against JN.1 lineage viruses,” Novavax CEO John Jacobs said in a statement.

Novavax said it expects its shot to be “broadly available” in thousands of locations across the U.S., including retail and independent pharmacies and regional grocers.

Shares of Novavax rose more than 8% on Friday following the announcement. 

The FDA’s decision comes only a week after it approved a new round of messenger RNA shots from Pfizer and Moderna, which both target another offshoot of JN.1 called KP.2. Last year, the agency authorized Novavax’s shot nearly a month after clearing vaccines from its rivals, putting the company at a disadvantage. 

Public health officials see Novavax’s vaccine as a valuable alternative for people who don’t want to take mRNA shots from Pfizer and Moderna, which use a newer vaccine method to teach cells how to make proteins that trigger an immune response against Covid. Novavax’s shot, meanwhile, fends off the virus with protein-based technology, a decades-old method used in routine vaccinations against hepatitis B and shingles.

It’s unclear how many people will get a new Covid shot this fall and winter. 

Only around 22.5% of U.S. adults received the latest round of shots that came out last fall, according to CDC data through early May. 

A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

It was the first time any living human had received a pig organ transplant.

“You never know what the news is, but my dad opened his eyes, and he was awake, and he was doing well. It was incredible,” Bennett Jr. said.

Bennett’s father, David Bennett Sr., had severe congestive heart failure and wasn’t a candidate for a human transplant. He knew he would likely die soon. There was nothing more to do — other than take a chance on a novel, cutting-edge surgery. Bennett Sr. and his son agreed it was worth the risk.  

The achievement made headlines around the world after the transplant surgery in January 2022. The results at first seemed promising, and some family members even began to entertain the idea that Bennett Sr. might eventually leave the hospital.

“There were definitely futuristic conversations, just about home setup and who was going to take care of him and how that would look,” Bennett Jr. said. “Everybody was very optimistic and hopeful.”

But two months later, Bennett Sr.’s body rejected the heart and he died at age 57. In a paper, his doctors at the University of Maryland Medical Center explained that his body had likely produced too many antibodies that fought off the new organ. A drug he’d been given may also have increased the odds of rejection, and a virus in the pig heart further complicated matters. 

Three other patients have followed in Bennett Sr.’s footsteps and received pig organs, most recently a pig kidney transplant in April. Together, they represent the pioneer patients of the burgeoning field of xenotransplantation. For their families, three of which spoke to NBC News about the experience, the journey came with a roller coaster of emotions, from uncertainty to blind hope — and, ultimately, admiration for their loved one’s decision. 

“I would love to still have my dad here, obviously, but I know that his sacrifice wasn’t for nothing,” Bennett Jr. said.

None of the patients survived more than three months. To the public, that might seem like failure. But to the families, the transplants accomplished their goals: to buy their loved ones more time and advance research that could potentially save lives one day.

“Larry approached it in this way: He was going to die. It was inevitable, and it was coming soon,” said Ann Faucette, whose husband of nearly 38 years, Lawrence Faucette, was the second person to receive a pig heart. “So why not offer up his body as a test subject for them to get as much data, do as much research as they could, so in the future there’s that other option for people who need those transplants?”

The promise of xenotransplants lies in the shortage of available human organs. An estimated 17 people die in the U.S. each day waiting for an organ transplant, according to the Health Resources and Services Administration. Because pig organs are more readily available, doctors envision a future in which these operations are as common as a hip replacement. 

But at this early stage, the Food and Drug Administration has only approved xenotransplants for patients on the verge of death with no other options. 

Like Bennett Sr., Lawrence Faucette qualified for a pig heart because he was dying of heart failure. Ann Faucette said that after the surgery, her husband was able to play cards and do physical therapy on an exercise bike. It was a contrast to the day before the surgery, when his heart had stopped and needed to be revived with an internal defibrillator. 

“We’re having full-on conversations. We’re watching football,” Ann said. “It’s like normal life, as normal as it can be in a hospital.”

She focused on the positives: “I was in denial. This was going to work. He was going to get better. He was going to come home,” Ann said.

Her two sons, now 29 and 31, “saw that the end could be at any point, so they made sure that they told Larry how they felt,” she added — that they loved him.

At her husband’s request, Ann bought a new chair for their house in Frederick, Maryland, in preparation for his return. The day it was delivered, she learned his condition had worsened.

“While I’m waiting for the chair, I get the call that they want to put Larry on ECMO,” she said, referring to a life-support device.

He died of transplant rejection roughly two weeks later, less than six weeks after the surgery. 

His doctors said Faucette’s recovery was complicated by the fact that his strength had declined shortly before the operation. 

The two xenotransplants after that followed a similar pattern: After surgery, the patients began to feel much better, then suddenly worsened after several weeks.

Brittany Harvill’s mother, Lisa Pisano, received a genetically modified pig kidney in April. Within a week, she had noticeably improved, Harvill said.

“She’s like, ‘I feel great.’ You could see the color in her face,” she said. “She looked like a whole new person.”

Before the surgery, Pisano could hardly walk due to shortness of breath and extreme fatigue. She had heart and kidney failure, so her surgery was more complicated than the others: Doctors implanted a mechanical heart pump eight days before the pig kidney. After the surgery, Pisano seemed more alert than ever, according to Harvill. She FaceTimed her grandchildren from the hospital, watched cooking shows and hung out with her daughter.

“I would bring pictures and then we would talk about what the kids were up to,” Harvill said.

But the demands of the transplant proved too much for Pisano’s other organs. Doctors prescribed blood-pressure medication, but it ultimately led to the rejection of the kidney. Pisano died in hospice care on July 7, around 12 weeks after the transplant.

Harvill said her mom was confident in her decision, but she still wishes Pisano had lived long enough to see her granddaughter, Olivia, go off to kindergarten.

“One thing that upsets me is that my mom would have loved to be there for that,” she said through tears.

Harvill believes the kidney transplant “100% would have worked” had it not been for her mom’s heart issues.

“Now I think the doctors definitely know, people that are as sick as my mom maybe aren’t the best people to do it,” she said.

Indeed, the surgeons who’ve done the xenotransplants and other experts in the field say these first four patients were not ideal candidates, since those on death’s door are likely to be too weak to support a new organ.

“If we could choose patients who are much more likely to do well, then we’d get a better idea about how successful it’s going to be,” said Dr. David Cooper, a physician investigator of transplant surgery at the Massachusetts General Research Institute, who did not perform any of the operations.

But for the FDA to approve such a transplant in a healthier patient, Cooper said, the agency wants to see more consistent one-year survival in studies done in animals. Privately, doctors had hoped that would be the case for the human patients. 

“We hoped for six months, and maybe a year. Out of ignorance, we felt our animal data supported that. We actually thought we’d do better in the humans,” said Dr. Bartley Griffith, clinical director of the cardiac xenotransplantation program at the University of Maryland School of Medicine, who operated on Faucette and Bennett Sr.

The only xenotransplant patient who recovered enough to return home was Rick Slayman, who received a pig kidney at Massachusetts General Hospital in March. He had terminal kidney disease, diabetes, high blood pressure and heart disease. 

Slayman’s family declined to be interviewed. According to his surgeon, Dr. Tatsuo Kawai, the dialysis Slayman had required before the transplant was no longer needed afterward, and his only struggle was climbing the three flights of stairs to his apartment.

Still, Slayman died less than eight weeks after his surgery, from what doctors suspect was a fatal arrhythmia. An autopsy showed that his heart disease was more advanced than his doctors had thought.

“The autopsy didn’t show any rejection or any abnormality in the kidneys, so in terms of transplant, we think this was successful,” said Kawai, who directs the Legorreta Center for Clinical Transplant Tolerance at Mass General.

The Bennett, Faucette and Harvill families do not regret their loved ones’ participation in the experimental transplants. Each saw any extra time as a gift, and they remain optimistic about xenotransplantation’s potential. Harvill compared the situation to the first human heart transplant in 1967. That patient died after 18 days, but thousands of such transplants are now performed in the U.S. each year.

The families are also aware of how much doctors learned from each surgery.

“The excitement in their voices and on their faces when they talk about the data that Larry was able to give them … it makes me grateful,” Faucette said.

On her wedding anniversary, she baked around 500 cookies for the hospital’s nursing staff.

Dr. Robert Montgomery, who did Pisano’s surgery and directs the NYU Langone Transplant Institute, said many people on the transplant waiting list are interested in a xenotransplant.

“I can’t tell you how many people call my office every week who want this. That’s what I think is underappreciated, is how desperate people are,” he said.

All of the researchers are eager to try another transplant as soon as they can find the right candidate and get FDA approval.

“We are at a place now where we feel 100% better informed,” Griffith said. “Whether that’ll translate to our next patient living a year, we’re not sure, but we moved from total ignorance to a really good idea of what our enemy is.”

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Wright, a Purple Heart recipient and a retired U.S. Army Staff Sergeant, received in-patient treatment in 2013 for post-traumatic stress disorder and anxiety.

“I wasn’t participating with them because I didn’t trust them,” Wright tells TODAY.com of his care team.

He eventually decided to start doodling during sessions to pass the time.

“Next thing you know, they were like the meeting is over. And I’m like, ‘OK, that’s crazy. It went by so fast.’ And they were like, ‘Today was a great day for you. You were talking. You were expressing yourself.’ I found out the whole time I was drawing, I was talking and engaging with the people,” Wright recalls.

After he completed his in-patient care, Wright says he went to get a tattoo. He had a good experience with the artist, who was also a friend who encouraged him to become a tattoo artist.

“Maybe I can do this,” Wright remembers thinking to himself. “I knew (that) I knew how to draw. I’ve been drawing since I was probably 2 years old. I bought a little kit. Never turned around.”

Wright has more than 100 tattoos himself and has given out thousands to people across the country to advance his mission of bringing mental wellness through tattoos.

His business, Marzmade Mobile Tattoo Studio, is based in New Jersey. He has a parlor in his home and a converted bus he uses to bring tattoos to people. He’s also on TV, with appearances in “Power Book III: Raising Kanan” and “Black Ink Crew: Chicago.”

Wright is among a cohort of veterans living with PTSD and anxiety. A 2024 study published in the Journal of Psychiatric Research estimated that 3 in 10 U.S. veterans report anxiety symptoms. According to the U.S. Department of Veterans Affairs, that 7% of veterans experience PTSD at some point in their lives.

For fellow veterans, Wright offers free tattoos so they can experience the lightbulb moment he did through art. He has given away more than 1,000 tattoos to them.

“I saw the correlation of tattooing and trauma, and I know about the trauma we have, especially when we get out,” Wright says. “I have tattoos over battle scars, and I’ve also tattooed over battle scars.”

Wright says most of the veterans he inks get tattoos in honor of their military service, and they trade war stories during the session.

“I can talk to you about the things you’re going through because I’ve been through it … as well as giving you a dope tattoo,” he adds.

Wright’s approach is clinically sound, experts say.

‘Reintegrate that painful memory’

Chase Cassine, a licensed clinical social worker in New Orleans who has worked with veterans, describes Wright’s work as “reintegration through tattoo therapy.”

“This is beneficial to both the tattoo artist and the person receiving the tattoo,” Cassine tells TODAY.com

“The tattoo is a symbol. The tattoo can also symbolize being a part of a group, being a part of a status, being able to commemorate a memory. But, also in that memory may be (another) painful memory. So you talk about what has happened and you can reintegrate that painful memory to a meaningful memory as a way to take back your power,” Cassine explains.

Tattoo therapy with Wright was particularly effective for Matt Davies, a Navy veteran who received a tattoo from Wright in 2020. Davies, who lives with PTSD, says he previously saw licensed therapists whom he did not find helpful.

“It felt more comfortable to talk with Daniel about the things that had happened to me than … with a licensed therapist because most therapists that you go to with the VA have no military background, so you’re speaking one language and they’re speaking another,” Davies says.

“It does get frustrating when you’re trying to convey what is happening, and you’re using terms that only a service member would use,” Davis adds. “This makes the ability to talk about it so much easier.”

‘Mimicking wartime adrenaline’

There’s also the physical side of getting a tattoo that helps, Wright and Cassine say.

“In the process of (getting) that tattoo, your adrenaline is so high that it’s mimicking wartime adrenaline,” Wright says. “When you were in wartime, you saw things. You smelled things. You heard things. Just think about it like this lid was opened and all of these smells and sensory things were put into your jar, and then it closed when you left wartime. And you’ve never had that much adrenaline to open it up again. I’m giving you that adrenaline to open a jar, and we’re talking about it to help release it.”

Davies says tattoo therapy helped him unlock “answers” he hadn’t previously known.

“When I went to meet with Daniel, we started talking about our time in the service, which led into a deeper conversation as to the things that we miss, the traumas that are associated with being in the service and also acclimating to life outside of the military,” Davies says.

“I believe my session was around five hours long, and we talked the entire time. It was very profound because I was able to finally feel like I got answers and not feel so alone or isolated with my feelings,” Davies adds.

Raising awareness of tattoo therapy

Wright mainly uses social media and digital platforms to advertise the free tattoos that he offers veterans. He has interested veterans enter a raffle and the winner gets the tattoo.

Davies says social media is how he heard about Wright. Davies won the raffle and they “hit if off” from there.

Cassine says tattoo therapy is a novel way to have impactful mental health conversations that actually land with the person.

“It may not be traditional, and sometimes we’ve got to get out of that framework, too. They have found therapeutic ways to help them cope with stress, with faith, with love, with trauma — tattoo therapy, speaking therapy, all these different things,” Cassine says.

There are other shops offering tattoo therapy, such as Tattoo Therapy BK and Therapy Ink NYC.

But Wright appears to be one of the only artists offering free tattoos for veterans.

“Everybody says the military is a band of brothers and sisters, and that is true,” Wright says. “But, when you get out or retire, it’s like you’re out of sight, out of mind. Everybody forgets about you. It’s not the same camaraderie you had every day. And that is one of the biggest traumas we deal with. I started bridging that gap.”

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A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

The man, identified by his family as Steven Perry, tested positive for the virus known as EEE or triple E, and was hospitalized with severe central nervous system disease, the New Hampshire Department of Health and Human Services said on Tuesday.

Perry was a resident of Hampstead, a town in southern New Hampshire about 45 miles north of Boston.

The 41-year-old was healthy and had no underlying medical conditions, his family told affiliate NBC Boston. However, Perry’s disease progressed rapidly, and he went to the hospital on Aug. 12.

Perry died one week later at Massachusetts General Hospital on Aug. 19, 2024, according to his obituary.

“It is with heavy hearts that the family acknowledges that Steven left those that he loved far too soon after being stricken by a sudden and rare brain infection,” the obituary read.

Previously, Perry tested positive for eastern equine encephalitis, a rare infection caused by a virus spread to humans through the bite of an infected mosquito, TODAY.com previously reported.

It is the first human case of eastern equine encephalitis in New Hampshire in 10 years. The last human EEE infection reported in the state was in 2014, when authorities identified three cases, including two deaths, the DHHS said.

EEE cases have also been reported in Massachusetts, Vermont, Wisconsin and New Jersey.

So far in 2024, at least five human cases of eastern equine encephalitis have been confirmed in the U.S. All five were the more severe (neuroinvasive) form of the disease, according to the latest data from the U.S. Centers for Disease Control and Prevention.

At this time, the case count is on par with previous years. Only a handful of cases are reported in the U.S. annually — in 2019, there were 38, the highest in a decade, TODAY.com reported previously.

Most people infected with EEE do not develop symptoms. If symptoms do occur, these typically begin two to 10 days after being bitten by a mosquito and include fever, chills, muscle aches, and joint pain.

EEE can also cause severe neurologic disease. About 5% of people infected with the virus develop severe swelling of the brain or the spinal cord, Dr. Daniel Pastula, chief of neuro-infectious diseases and global neurology at the University of Colorado School of Medicine, previously told TODAY.com.

Symptoms of neuroinvasive EEE include a high fever, behavioral changes, vomiting, seizures and coma. About 30% of people with EEE will die, per the CDC. However, many survivors are left with lasting mental and physical problems.

Most cases are reported between July and September, with activity peaking around August. As the end of summer approaches and the U.S. enters peak mosquito season, the threat of mosquito-borne diseases looms.

“We believe there is an elevated risk for EEEV infections this year in New England given the positive mosquito samples identified,” New Hampshire state epidemiologist Dr. Benjamin Chan said in a release.

In Massachusetts, several communities are on high alert due to a recent case of EEE in a man in his 80s. The case has prompted officials to spray for mosquitoes and some towns to enact voluntary curfews and nighttime park closures.

What’s more, the U.S. is also seeing increased activity of another mosquito-borne virus, West Nile. As of Aug. 27, there have been 289 cases of West Nile virus reported in 33 states, per CDC data.

There is no treatment or vaccine for eastern equine encephalitis. Preventing mosquito bites is the best way to protect yourself against EEE and other mosquito-borne diseases.

The CDC recommends people take the following steps:

•  Use an EPA-registered insect repellent
• Wear pants and long sleeve shirts outdoors
• Limit activity outdoors from dusk to dawn, when mosquitoes are most active

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A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

The study tracked 30 years of living kidney donation and found that by 2022, fewer than 1 of every 10,000 donors died within three months of the surgery. Transplant centers have been using older data – citing a risk of 3 deaths per 10,000 living donors – in counseling donors about potentially deadly surgical complications.

“The last decade has become a lot more safe in the operating room for living donors,” said Dr. Dorry Segev, a transplant surgeon at NYU Langone Health. He co-authored the study published in the journal JAMA.

Newer surgical techniques are the key reason, said Segev, calling for guideline updates to reflect those safety improvements – and maybe increase interest in living donation.

He often finds transplant recipients more worried about potential risks to their donors than the would-be donors themselves.

“For them, this is even more reassuring to allow their friends or family to donate on their behalf,” Segev said.

Thousands of people die each year waiting for an organ transplant. It’s possible for living donors to give a one of their two kidneys or part of a liver, the only organ that regenerates.

With nearly 90,000 people on the U.S. list for a kidney transplant, finding a living donor not only shortens the yearslong wait — those organs also tend to survive longer than ones from deceased donors.

Yet last year, just 6,290 of the nation’s more than 27,000 kidney transplants came from living donors, the most since before the pandemic. Safety isn’t the only barrier to living donation. So is awareness, as many patients are reluctant to ask. And while the recipient’s insurance covers medical bills, some donors face expenses such as travel or lost wages as they recover.

The NYU team analyzed U.S. records of more than 164,000 living kidney donations from 1993 through 2022 and found 36 post-surgical deaths. Most at risk were male donors and those with a history of high blood pressure.

Only five of those deaths occurred since 2013. That period coincided with U.S. transplant centers switching to minimally invasive kidney removal as well as adopting a better way to stop renal artery bleeding, Segev said.

“Over time, it’s a safe operation that’s become even safer,” important for would-be donors to know, said Dr. Amit Tevar of the University of Pittsburgh Medical Center, who wasn’t involved in the study.

But there are long-term risks to consider, too, he stressed — including whether a donor’s remaining kidney is expected to last the rest of their life.

The risk of a donor later experiencing kidney failure also is small and depends on such factors as obesity, high blood pressure, smoking and family history of kidney disease. Risk calculators help doctors determine a potential donor’s likelihood of later-in-life trouble, and transplant centers may have slightly different eligibility criteria.

“There’s no such thing as a moderate- or high-risk donor — either you’re perfect or you’re not,” is how Tevar puts the decision to accept or turn away a potential donor.

Doctors once thought young adults were the ideal living donor. But Segev said there’s a shift toward more older living donors because it’s easier to correctly predict that they won’t outlive their remaining kidney.

If a living donor later experiences kidney failure, they get priority for a transplant, he noted.

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

A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

TikTokers have seized on the treat’s mouthwatering colors and popularized a quick method involving the microwave. They promise the signature glassy coating with only a couple of ingredients and in just five minutes, but doctors in multiple countries are speaking out to warn parents of an uptick in burns, some severe enough to require skin grafts.

In order to reach the “hard crack” stage for that shiny coating, sugar must be heated to at least 300 F, much hotter than just boiling water. And, because it is sticky and viscous, it can result in prolonged skin contact that may make a scalding injury much more dangerous.

Surgeon Dr. Colleen Ryan of Boston hospital Shriners Children’s said in an Aug. 14 press release that they recently saw two patients with just this injury in the space of only two weeks, and that international word of mouth among doctors is reporting multiple cases of deep burns occurring with the technique shown on social media.

Australian food scientist and dietitian Ann Reardon of How to Cook That is sounding the alarm as well, in a YouTube video explaining the potential dangers of using an appliance that can only accommodate plastic or glass, for a recipe that should be made in a heatproof metal pan. As she shows in the video, even microwave-safe plastic containers can collapse or leak molten sugar at those high temperatures. Other injuries, she reports, could result if a superheated glass container is moved from the microwave to a cold kitchen counter, where the temperature shift can cause shattering.

Does this mean that gorgeous homemade tanghulu is out of reach? Although it must be done with proper equipment and appropriate supervision, working with sugar syrup is absolutely possible in a home kitchen — if you know the right tricks.

When we caught up with content creator Emmy Cho of Emmymade to ask about her own tanghulu attempt, she recounted something of a journey to getting the glassy texture just right.

“It’s so beautiful and catches people’s eyes, but for me, it was a real lesson in sugar chemistry,” Cho told TODAY.com. Her first attempt seized up, but she found the key was adding corn syrup, which interferes with the organization of the sucrose molecules into crystals. She also found that you really do have to heat it to that scorching 300 F to get that characteristic crunch.

Cho reiterates the messages that sugar syrups should never be made in the microwave, and that kids must have supervision even if using a metal pan on the stovetop.

“I think I kind of equate it to deep-fat frying,” she says, “but even more dangerous, because it’s sticky.”

That said, she hopes parents will take this warning to heart by seeking out ways to include their children in meal preparation, safely.

“I’m all for experimenting!” Cho says. “You have to teach your kids how to cook, both so they are capable and for their long term health.” She suggests “finding their interest point,” noting that while one of her kids enjoys helping cook entire meals with her, the other is more interested in the math of weighing baking ingredients. She has taken a gradual approach to making sure they know their way around the kitchen.

“It’s small steps — first they had to make their own breakfast, and then later they had to pack their snacks.” These days, they’re responsible for making their own lunches in addition to participating in dinner prep.

That time spent together will lead to the competence that can help prevent kitchen accidents like burns.

You could even make her new fried chicken version of tanghulu: “Glass KFC.” As Cho always says, “Take a big bite!” —  just don’t use the microwave.

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

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Fauci, who also served as the chief medical adviser for the Biden administration, was sent home on Saturday and is now recovering, according to his spokesperson. He is expected to fully recover.

The virus first entered the U.S. in 1999, and it has become the leading cause of mosquito-borne disease in the country, per the CDC. 

According to the Department of Health and Human Services, the West Nile virus (WNV) is the most common mosquito-borne disease in the US, and around 2,205 cases are reported each year.

But what is the West Nile virus and what are its symptoms? Here’s what to know

What is the West Nile Virus?

The West Nile virus is a disease that most commonly spreads through mosquito bites, according to the Centers for Disease Control and Prevention.

The virus was first detected in the U.S. in 1999 after two men in New York City tested positive for the virus, which it is believed first arrived in the country through an infected mosquito or bird.

So far, over 200 cases of West Nile have been detected nationwide in 2024, according to CDC data.

What are the symptoms of West Nile virus?

Approximately 80% of the people infected with WNV will not develop any symptoms. 20% will experience mild flu-like symptoms such as fever and less than 1% will develop severe long-term effects which sometimes can be deadly, according to HHS.

The symptoms include:

• Body aches
• Diarrhea
• Fever
• Headache
• Vomiting

Among the most serious complications are meningitis, paralysis or death.

When do West Nile symptoms start to show?

Symptoms generally appear between two to 14 days after being bitten but sometimes it could be several weeks before symptoms show up in immunocompromised people, according to the CDC.

How to cure West Nile virus?

According to the CDC, there is no specific treatment for West Nile virus though doctors usually recommend pain medication for headaches and antiemetic therapy and rehydration to treat nausea and vomiting.

How to protect yourself from West Nile virus?

The best way to protect yourself from West Nile is to dress in loose-fitting clothing that covers arms and legs when outside. Using air conditioning and adding screens to open doors and windows is also recommended.

Fauci, 83, who was chief medical adviser to President Joe Biden, became a household name during the Covid pandemic. Fauci left as director of the National Institute of Allergy and Infectious Diseases in 2022.

“Tony Fauci has been hospitalized with a case of West Nile virus. He is now home and is recovering,” a spokesperson said in a statement Saturday.

He is expected to make a full recovery.

West Nile virus is commonly spread through infected mosquitos, and there is no vaccine or treatment. As of Aug. 24, there were 216 human West Nile cases reported in 33 states. Of those cases, 142 were neuroinvasive, meaning people developed a severe form of the disease such as inflammation of the brain or the membranes surrounding the brain and spinal cord. These cases typically require hospitalization.

Several hundred to several thousand cases are reported in the United States each year. Most cases are reported in August and September.

Disease experts said that more West Nile virus had been circulating this summer than was expected, with at least seven states having confirmed human cases by June 25. A record-breaking number of mosquitoes in and around Las Vegas were found to have been carrying the virus earlier this year.

This article first appeared on NBCNews.com. Read more from NBC News here:

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Here are some of their top tips for getting a good night’s rest.

4 tips for a good night’s rest from sleep experts

1. Consider these 5 signs you might need a sleep divorce

A sleep divorce is not as drastic as it sounds. It simply means sleeping apart from your partner, whether in separate beds or separate bedrooms, to get the best sleep, Shelby Harris, a licensed clinical psychologist and director of sleep health at Sleepopolis, told Make It in 2022.

“I actually recommend that couples sometimes do this, and it doesn’t mean that their relationship is in trouble,” Harris said. “It just means they’re actually valuing their relationship and their health as well.”

You may want to consider a sleep divorce if you, and/or your partner:

• Snore loudly
• Have different sleep patterns/schedules (early bird vs. night owl)
• Move a lot while sleeping
• Are a light sleeper or find that alarms interrupt your sleep
• Have different preferences when it comes to temperature of the room, bedding, etc.

Harris suggested trying to problem-solve first to see if you can sleep in the same bed peacefully. And if you decide to implement a sleep divorce, make sure it’s a mutual decision presented respectfully and that your sleeping arrangements are similar (not one partner sleeping on the couch while the other sleeps in a cozy bed).

2. Try a sleep expert’s bedtime routine

Dr. Richard Schwab, chief of the division of sleep medicine at the University of Pennsylvania Perelman School of Medicine, shared his sleep routine with Make It in 2022.

“I think the most important thing in terms of what I should do for my sleep is go to bed at the same time and get up at the same time, each day,” Schwab said.

His preferred sleep time is 11:30 p.m. and he usually wakes up at 6:30 a.m.

Schwab also determined through trial and error how many hours of sleep he needs each night. “I need about six or seven and half hours of sleep, and if I don’t get that I’m going to be sleepy,” he said.

To get optimal sleep, Schwab recommended setting the ambience in your room by making sure it’s your preferred temperature and light exposure. He also got a larger bed to accommodate his wife and children.

3. Make these simple changes if you’re a night owl with a 9-to-5 job

“We all have a slight genetic orientation to one of two types, either being a morning person or an evening person,” Rebecca Robbins, an assistant professor of medicine at Harvard Medical School’s Division of Sleep Medicine, told Make It in December of 2023.

Yet, the common 9-to-5 work schedule of many jobs just doesn’t align with the internal clocks of night owls, and that can be difficult.

Here are seven ways that Robbins suggests thriving at work as a night owl:

• Head outdoors and get enough sun exposure during the day
• Avoid caffeine in the afternoon
• Aim to follow the same sleep and wake time daily
• Use blue light devices like “happy lights” at work
• Workout in the morning
• Get certain things done in the evening like passion projects
• See if you can change your work schedule

4. Remember melatonin is a bit more effective for sleep than magnesium

Two popular supplements touted for prompting sleep are melatonin and magnesium, but of the two, one is more effective, according to licensed clinical psychologist Shelby Harris.

“Melatonin is the most common natural sleep aid that can help gradually shift the body’s circadian rhythm when taken properly,” Harris said in February.

“Before taking magnesium or melatonin for sleep, it’s important to establish proper sleep hygiene and habits.”

These are some suggestions Harris shared for developing good sleep hygiene:

• Stick to a consistent sleep schedule
• Relax before you plan to go to bed
• Stay off of your electronic devices directly before bedtime
• Don’t drink caffeine at least eight hours before sleeping

This “can all be helpful in enhancing your body’s natural melatonin production, thus making it easier to fall asleep.”

Are you stressed about money? Sign up for CNBC’s new online course. We’ll teach you how to be more successful and confident with your money, and practical strategies to boost savings, get out of debt and invest for the future. Start today and use code EARLYBIRD for an introductory discount of 30% off through September 2, 2024.

Plus, sign up for CNBC Make It’s newsletter to get tips and tricks for success at work, with money and in life.

My life has demanded a certain amount of courage. I was born in Cleveland, Ohio, in 1922, shortly after the start of Prohibition. My father, who was a bootlegger, got into a turf war with the mafia, and he was killed in our driveway when I was just two years old. 

I got married a month after my 19th birthday and went straight from my mother’s home to my husband’s. Three kids and 25 years later, I left that unhappy marriage and loved being out on my own.

In my 40s, I had my first experience of supporting myself and being myself. I started writing for newspapers and later, after I remarried, had the luxury of writing novels full time. 

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Today, as a 101-year-old in Austin, I’m living the kind of life I feel fortunate to have. I still do things I love — like publishing my ninth book earlier this year, spending time with people I love, and reading. It’s a quieter life than I had as a younger woman, but these years are good ones. I wish more people my age knew that. 

Here are eight lessons I’ve learned that have helped me live a long, happy life: 

1. Don’t ever believe you’re ‘done’

Some cultural ideas are good, but many are wrong. People give up on their lives much too early. 

When your mind focuses on what the culture teaches us — that we’re done when we get past a certain age — it gets into our sense of self. If our sense of self is to be alone and sad and useless when we are 70, 80, 90, whatever, we believe it. And that’s really dangerous. 

People have gifts that they may not know they have, and it may take a lifetime to find them. 

2. Talk to friends of all ages

My friends are a wonderful source of wisdom, energy and authenticity. 

I have a few friends that are two and three generations younger. I’ve learned from them, and I think they’ve learned from me. Each decade teaches us something else. 

There’s a huge difference between being 30 or 40 and being 90 or 100. And yet, when we come together, it can be fabulous because we all have much to teach each other. It gives us another way to think about things.

When I get together with my friends, we mostly talk. Talk is exhilarating when it’s good.

3. Let little things make your day

It’s not the top of the mountain that makes us happy. It’s the small pleasures. 

Our culture often tells us that if you want to be successful, it’s a big thing. It’s a big effort. It’s about big returns. But that doesn’t work. I don’t even know if the mountaintop exists, but small pleasures do exist, and they can be dynamite. 

We have to understand ourselves so that we can be authentic and find the little things that make us happy. For me, one is reading. Another is being with people I care deeply about — which can be family or friends. It’s a phone call, a visit, an idea, a worry shared. 

4. Have the courage to be authentic

Courage is probably, for me, the bottom line. It takes courage to look at yourself clearly, to know yourself, and to be authentic. 

But it gives you energy, confidence, and an understanding of yourself and others. In the long run, I believe that being authentic — disagreeing with someone, for example — makes even difficult relationships stronger. 

Being authentic doesn’t come easily. It takes some work to learn about yourself. But it’s worth it.

5. Do things you love

When I’m writing, I feel different. I feel better. I feel happier, I feel more centered. I feel more confident. Other writers I know tell me they feel the same thing. There’s really something magical about creative work. Of course, it’s not magic; it’s an expression of the human soul.

The pleasures you get from doing something creative that you love are tied to parts of the self that are not always available or conscious. 

It goes back to knowing yourself and being authentic. The way I get that is by writing. For someone else it might be painting or dancing. Sometimes I’ll come back and I’ll see something I wrote and think, “That’s good.” That means it opened my unconscious. That’s where the gems are.

6. Move your body, rest your mind

For about seven years, I’ve worked out with a trainer twice a week. For a 101-year-old, I’m strong. I can lift 10-pound weights and get up off a chair holding the weights. I’m so proud of that.

When I had pneumonia and I was in the hospital, someone there told me that my exercising probably saved my life. So it isn’t just a good idea — it’s essential.

At the same time, you have to get a lot of rest. The brain needs rest in order to rejuvenate.

7. Don’t get stuck in negativity

Negative thinking is common, and it’s a killer.

Why do some people feel optimistic and some, no matter what they say, it comes out negative? It’s how we’re born, I believe. We come into the world optimists or pessimists. Some people have such difficult times in their lives. If a pessimist would say, “Why me?” I would say, “Why not?”

It’s very hard to overcome negative thinking, but to the extent that we can, we need to acknowledge the positive and try to move forward with optimism.

8. Do what you know you need to do

As I’ve gotten older, I’ve often been asked, “What’s your secret?” I don’t have a secret.

Longevity is what everyone knows to be true. We all know: Exercise, good diet, a healthy personal relationship with a partner, an understanding of yourself, a career that’s good for you — these are the keys to a happy life. 

But there’s a gap between what we know and what we do. The problem for so many people is doing it. And that’s more mysterious than I can explain.

This as-told-to interview has been edited.

Babette Hughes is a writer who recently published her ninth book, “Lessons in Evil,” at the age of 101. She was born in Cleveland, Ohio, and grew up in the time of Prohibition and bootleggers. Though she’d previously published a memoir titled “Lost and Found,” she didn’t publish her first novel, “The Hat,” until 2015. She lives in Austin.

Stav Ziv is a contributors editor at CNBC Make It.

Are you stressed about money? Sign up for CNBC’s new online course. We’ll teach you how to be more successful and confident with your money, and practical strategies to boost savings, get out of debt and invest for the future. Start today and use code EARLYBIRD for an introductory discount of 30% off through September 2, 2024.

A team of dietitians at the hospital unloaded the week’s shipment of fresh food for patients with diabetes and pre-diabetes Thursday morning.

Then, they piled fresh green beans, apples, squash, carrots and other healthy foods into bags.

“Food is a huge part of the disease state,” said Sarah Roberts, a clinical dietitian for Children’s National. “It’s very important that families understand the importance of using these whole grains, these fruits and vegetables in their diet because when we’re looking at the disease state, we want to tackle it from all points.”

Pre-diabetes and diabetes patients with food insecurity at Children’s National receive three bags of food tailored to their medical needs as part of a food pharmacy program with the Capital Area Food Bank.

Roberts said they’ve seen an increase in patients reporting food insecurity in recent years. Patients’ guardians fill out screenings when they visit the hospital.

“That was another reason for starting the food pharmacy is not only the increase of food insecurity during the in the pandemic, but the increase of type 2 diabetes during the pandemic,” she said.

The proper foods can treat, prevent and, in some cases, reverse a diagnosis of diabetes, experts say.

“I’ve lost about 50-60 pounds just because I’ve been able to have good choices,” Children’s National patient Iman Bangura told News4 via a video call.

Bangura, who has type 2 diabetes, has been in the food pharmacy program for more than a year.

For her, the food pharmacy isn’t just her way out of a food desert, it’s helping change family history.

The food pharmacy served about 30 patients a month when the program began in 2021. Now, more than 200 families a month receive the fresh and healthy groceries.

Roberts said it’s been a vital tool in providing well-rounded care.

“If we’re in here doing these educations with these patients about fresh fruits and vegetables and they’re not able to purchase those things on their own and get those in the store, then it feels like we’re not fully meeting the needs of those patients,” she said.

The Biden administration on Friday said it will resume offering free at-home Covid-19 tests to American households in late September as the virus has gained a stronger foothold in the U.S. this summer.

Americans will soon be able to use COVIDtests.gov to request four free tests, administration officials told reporters during a briefing. The tests will be able to detect the Covid variants that are currently circulating, most of which are descendants of the highly contagious omicron variant JN.1. 

“These tests will help keep families and their loved ones safe this fall and winter season,” Dawn O’Connell, an assistant secretary for preparedness and response at the Health and Human Services Department, said during the briefing. “This is the seventh time over the last three years that the Biden-Harris administration has given families the opportunity to order the over-the-counter Covid-19 tests for free” through the government’s website.

The government’s program has provided more than 1.8 billion free over-the-counter Covid tests to Americans since it started in 2021, according to O’Connell.

The government is relaunching the program amid a relatively large spike in Covid cases this summer, and ahead of the fall and winter, when the virus typically spreads at higher levels each year. There is a “high” or “very high” level of Covid being detected in wastewater in almost every U.S. state, according to data from the Centers for Disease Control and Prevention. 

But the government decided to reopen the program in late September because it’s when more Americans begin to travel and gather indoors with loved ones. 

“As people start to travel, as they start to get together with friends and family through the holidays, we want them to have those four tests available to them at that time,” David Boucher, director of infectious disease preparedness and response at HHS, told reporters during the briefing.

By then, the latest round of Covid shots from Pfizer and Moderna will be available to most Americans in pharmacies, health clinics and other locations nationwide. The Food and Drug Administration approved those shots, which target a JN.1 offshoot called KP.2, on Thursday.

Testing is a critical tool for protection as Covid infections climb again. But lab PCR tests — the traditional method of detecting Covid — have become more expensive and less accessible for some Americans since the U.S. government ended the public health emergency in May last year. 

Still, certain local health clinics and community sites offer at-home tests to the public at no cost. 

Most research about HPV’s potential impact on fertility has focused on women. But in recent years, researchers have increasingly expanded their focus to include the infection’s association with male fertility.

A new study from Argentinian researchers has found that the strains of HPV considered high risk because of their links to cancer were not only more common than low-risk strains in a small study population of men, they also appeared to pose a greater threat to sperm quality.

The study, published Friday in Frontiers in Cellular and Infection Microbiology, found that high-risk HPV appears to suppress key components of the immune system in the male genital tract. This could hamper the body’s ability to clear HPV, a process that typically takes about six months to a year after infection, while raising the risk of other infections that may also compromise male fertility.

“Individuals often have no symptoms or signs, yet still carry HPV in the male genital tract,” said the study’s senior author, Virginia Rivero, a professor of immunology at the National University of Córdoba in Argentina.

A 2020 systematic review of 50 studies found that 21% of infertile men had HPV-positive semen, compared with 8% in the general male population. Even after accounting for female infertility, men with HPV in their semen had three-fold greater odds of being infertile than those without the virus.

There are over 200 known strains of HPV. The riskiest handful can cause multiple cancers, including, in the U.S., about 26,000 diagnoses in women and 21,000 in men each year, according to the Centers for Disease Control and Prevention. The most common HPV-driven malignancy is cervical cancer, with about 13,800 invasive cases annually. Research suggests that most people are unaware that the virus can also cause vulval, anal, throat, vaginal and penile cancer.

A vaccine for HPV has been available since 2006, when it was initially recommended just for girls; the recommendation was expanded to boys in 2011. The current version, which is given in a two- or three-dose series, prevents nine of the riskiest HPV strains, including those that cause genital warts.

The CDC recommends routine HPV vaccination for all boys and girls at 11 or 12 years old — children can receive it at as young as age 9 — and for those through age 26 who were not previously fully vaccinated. Experts consider the vaccine exceptionally safe.

A CDC study published Thursday found that for adolescents born in 2007, about 65% were fully vaccinated for HPV by age 15, compared with 60% of those born in 2008. The CDC attributes this statistically significant difference to disruptions from the Covid pandemic, beginning when the younger group turned 12.

Vaccination at older ages typically provides less benefit, since so many people contract at least one strain of HPV after becoming sexually active. But the CDC suggests that people up to age 45 may still discuss potential vaccination with their doctors. 

High-risk HPV lowers immune cells

In her new study, Rivero and her colleagues studied the ejaculate samples of 205 men, none of whom were vaccinated for HPV. The men, who had a median age of 35, sought a fertility assessment or treatment for urinary-tract problems from 2018 to 2021 at a urology clinic in Argentina.

Thirty-nine, or 19%, of the men tested positive for HPV. Researchers were able to identify 20 men among them who had high-risk strains and seven men with low-risk HPV.  

On the surface, the investigators didn’t find any notable differences in the semen quality between the men with either type of HPV and a group of 43 men who tested negative for the virus. When they examined the semen more closely with highly sensitive tools, they found clues suggesting how high-risk HPV strains might be influencing male infertility.

The men with high-risk HPV had a lower level of certain immune cells in their semen, suggesting the virus had hampered the body’s ability to fight it off. This suppression of immune cells might also have raised the men’s risk of other infections that could further compromise their ability to conceive.

There was also evidence that the sperm of the men with high-risk HPV were sustaining damage from what’s known as oxidative stress. This could explain why these men had a higher level of dead sperm compared with those who didn’t have the virus.

Dr. Eugenio Ventimiglia, an oncologist in the unit of urology at the Università Vita-Salute San Raffaele in Milan, Italy, said the new study, which he was not involved in, “provides insight into the biological mechanisms potentially linking HPV to male reproductive health issues.” 

Nevertheless, he said its findings should be “interpreted cautiously.”

“Instead of conclusively proving a cause-effect relationship between HPV and male factor infertility, the study’s findings are more appropriately seen as generating hypotheses for further research,” Ventimiglia said.

Can vaccination protect men’s fertility?

Men’s HPV might also affect fertility in part by transmitting the virus into the woman’s reproductive tract; the virus might then harm the pregnancy at various stages, including before the fertilized egg implants in the womb. Couples receiving assisted reproductive technology have a greater chance of miscarriage if the man has HPV in his semen, researchers have found.

Research indicates that providing the HPV vaccine to men who are having trouble conceiving and who have an active HPV infection might help them clear the virus faster and potentially improve their chances of conceiving.

“Whatever other changes are thought to be associated with HPV, it should be noted that HPV infection is usually brief, as is the sperm lifespan,” said Dr. Marie-Hélène Mayrand, an epidemiologist and the chair of the obstetrics and gynecology department of University of Montreal. “This is reassuring that any effect, if found, would be brief and self-limited.” Mayrand was not involved in the new research.

Rivero advises that men struggling with fertility receive testing for HPV and other sexually transmitted infections that could affect their fertility. If positive for HPV, additional testing may be needed to identify specific strains. 

The test results, Rivero said, could help men identify a potential driver of their infertility. 

HPV vaccination rates among adolescent boys and men have been rising over the last decade. Recent research suggested that the HPV vaccine was linked to a drastically lower rate of head and neck cancers in men and adolescent boys. 

It’s not yet known if the vaccine could protect men’s fertility. 

“When a critical mass of boys and girls are vaccinated, it is likely that the transmission of the HPV genotypes covered by the vaccines will decrease.” Rivero said. “But the broader impact on fertility remains uncertain.”

Rivero said she hoped to see a larger study in the future that could lend more statistical heft to her findings. Her own lab plans to further study how simultaneous infections with HPV and other STIs might influence male fertility.

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

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“That’s my dad!” 17-year-old Gus Walz could be seen exclaiming Wednesday night. He stood, tears streaming down his face, and pointed to his father, the governor of Minnesota, who accepted the party nomination for vice president.

Gus wept through much of the 16-minute speech, and took the stage with his family afterward, wrapping his dad in a tight bear hug, burying his face in his shoulder.

The high school senior’s joy quickly went viral. He was still trending Thursday on X, the social media platform formerly known as Twitter. And his newfound fame is focusing attention on the challenges of people with learning disabilities. His parents recently revealed to People magazine that Gus has ADHD, an anxiety disorder and something called a non-verbal learning disorder. Searches on Google have spiked since Wednesday night this week for the disorder and for the teen’s name.

There’s no standard definition for non-verbal learning disorder. It doesn’t mean people with it can’t talk. But according to the NVLD Project at Columbia University, people with it “struggle with a range of conditions that include social and spatial disabilities. Often they are marginalized and isolated; consequently, they can experience social barriers throughout their lives.”

There has long been tension between Washington and local school districts over federal funding of special education. Federal law requires schools to provide special education services, but doesn’t come close to covering the costs. When passed in 1975, the Individuals with Disabilities Education Act (IDEA) committed the federal government to paying 40% of the average per-pupil expenditure for special education. But currently it’s more like 13%.

That’s one reason the Democratic Party platform adopted at the convention this week says, “We support fully funding IDEA to prioritize students with disabilities and the special educator workforce.” This year’s Republican Party platform doesn’t mention special education. But dozens of national education groups have long called for fully funding the costs that IDEA imposes on local schools.

The actual prospects for more money under a Harris-Walz administration are unclear. Much would depend on the future federal budget picture and the composition of the next Congress. And platforms aren’t binding on candidates.

But Walz as governor has approved large increases in education funding, including special education. The two-year budget he signed in 2024 included a 6% increase in per-pupil funding for local schools, and it indexes future funding to inflation. It also included a large boost in state support for special education to help fill the gap in federal funding.

Securing full funding for special education on the national level is the “number one public policy priority” of the National Association of State Directors of Special Education, said John Eisenberg, the group’s executive director. The association calls the federal act “first and foremost a civil rights law, meant to protect the right of students with disabilities to be educated in the nation’s public schools.”

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While bills to mandate full funding have attracted bipartisan support over the years, they’ve failed to become law.

Gov. Walz, a former social studies teacher, and first lady Gwen Walz, a former English teacher, revealed Gus’ learning issues in a statement to People magazine that was published this week.

“When our youngest Gus was growing up, it became increasingly clear that he was different from his classmates,” they said. “Gus preferred video games and spending more time by himself.” They went on to say, “When he was becoming a teenager, we learned that Gus has a non-verbal learning disorder in addition to an anxiety disorder and ADHD, conditions that millions of Americans also have.”

The Walzes told People that it took time to figure out how to set Gus up for future success, “but what became so immediately clear to us was that Gus’ condition is not a setback — it’s his secret power.”

They also said he’s “brilliant, hyper-aware of details that many of us pass by, and above all else, he’s an excellent son.” They didn’t go into detail about how his condition has affected his life, however, and the Walz campaign did not immediately respond to a request for comment Thursday. They have previously noted that Gus got his driver’s license last fall.

Associated Press reporter Heather Hollingsworth contributed to this story from Mission, Kansas.

With the Food and Drug Administration’s clearance, Pfizer and Moderna are set to begin shipping millions of doses. A third U.S. manufacturer, Novavax, expects its updated vaccine version to be available a little later.

“We strongly encourage those who are eligible to consider receiving an updated COVID-19 vaccine to provide better protection against currently circulating variants,” said FDA vaccine chief Dr. Peter Marks.

The agency’s decision came a bit earlier than last year’s rollout of updated COVID-19 vaccines, as a summer wave of the virus continues in most of the country. The Centers for Disease Control and Prevention already has recommended this fall’s shot for everyone age 6 months and older. Vaccinations could be available within days.

While most Americans have some degree of immunity from prior infections or vaccinations or both, that protection wanes. Last fall’s shots targeted a different part of the coronavirus family tree, a strain that’s no longer circulating — and CDC data shows only about 22.5% of adults and 14% of children received it.

Skipping the new shot is “a hazardous way to go,” because even if your last infection was mild, your next might be worse or leave you with long COVID symptoms, said Dr. Robert Hopkins Jr. of the National Foundation for Infectious Diseases.

This fall’s vaccine recipe is tailored to a newer branch of omicron descendants. The Pfizer and Moderna shots target a subtype called KP.2 that was common earlier this year. While additional offshoots, particularly KP.3.1.1, now are spreading, they’re closely enough related that the vaccines promise cross-protection. A Pfizer spokesman said the company submitted data to FDA showing its updated vaccine “generates a substantially improved response” against multiple virus subtypes compared to last fall’s vaccine.

The big question: How soon to get vaccinated? This summer’s wave of COVID-19 isn’t over but the inevitable winter surges tend to be worse. And while COVID-19 vaccines do a good job preventing severe disease, hospitalization and death, protection against mild infection lasts only a few months.

People who are at high risk from the virus shouldn’t wait but instead schedule vaccinations once shots are available in their area, Hopkins advised.

That includes older adults, people with weak immune systems or other serious medical problems, nursing home residents and pregnant women.

Healthy younger adults and children “can get vaccinated anytime. I don’t think there’s a real reason to wait,” Hopkins said – although it’s OK to seek the shots in the fall, when plenty of doses will have arrived at pharmacies and doctor’s offices.

The exception: The CDC says anyone who recently had COVID-19 can wait three months after they recover before getting vaccinated, until immunity from that infection begins to wane.

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Hopkins, who sees patients at the University of Arkansas for Medical Sciences, calls it vital for more youngsters to get vaccinated this year – especially with schools starting as coronavirus levels are high around the country.

“COVID does not kill many children, thank goodness, but it kills far more children than influenza does,” Hopkins said, adding that teachers, too, should quickly get up to date with the vaccine.

Health authorities say it’s fine to get a COVID-19 and flu vaccination at the same time, a convenience so people don’t have to make two trips. But while many drugstores already are advertising flu shots, the prime time for that vaccination tends to be late September through October, just before flu typically starts its cold weather climb.

The report, based on an analysis of previously published research, marks the first time a federal agency has determined — “with moderate confidence” — that there is a link between higher levels of fluoride exposure and lower IQ in kids. While the report was not designed to evaluate the health effects of fluoride in drinking water alone, it is a striking acknowledgment of a potential neurological risk from high levels of fluoride.

Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the U.S. Centers for Disease Control and Prevention. The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century.

“I think this (report) is crucial in our understanding” of this risk, said Ashley Malin, a University of Florida researcher who has studied the affect of higher fluoride levels in pregnant women on their children. She called it the most rigorously conducted report of its kind.

The long-awaited report released Wednesday comes from the National Toxicology Program, part of the Department of Health and Human Services. It summarizes a review of studies, conducted in Canada, China, India, Iran, Pakistan, and Mexico, that concludes that drinking water containing more than 1.5 milligrams of fluoride per liter is consistently associated with lower IQs in kids.

The report did not try to quantify exactly how many IQ points might be lost at different levels of fluoride exposure. But some of the studies reviewed in the report suggested IQ was 2 to 5 points lower in children who’d had higher exposures.

Since 2015, federal health officials have recommended a fluoridation level of 0.7 milligrams per liter of water, and for five decades before the recommended upper range was 1.2. The World Health Organization has set a safe limit for fluoride in drinking water of 1.5.

The report said that about 0.6% of the U.S. population — about 1.9 million people — are on water systems with naturally occurring fluoride levels of 1.5 milligrams or higher.

“The findings from this report raise the questions about how these people can be protected and what makes the most sense,” Malin said.

The 324-page report did not reach a conclusion about the risks of lower levels of fluoride, saying more study is needed. It also did not answer what high levels of fluoride might do to adults.

The American Dental Association, which champions water fluoridation, had been critical of earlier versions of the new analysis and Malin’s research. Asked for comment, a spokeswoman late Wednesday afternoon emailed that the organization’s experts were still reviewing the report.

Fluoride is a mineral that exists naturally in water and soil. About 80 years ago, scientists discovered that people whose supplies naturally had more fluoride also had fewer cavities, triggering a push to get more Americans to use fluoride for better dental health.

In 1945, Grand Rapids, Michigan became the first U.S. city to start adding fluoride to tap water. In 1950, federal officials endorsed water fluoridation to prevent tooth decay, and continued to promote it even after fluoride toothpaste brands hit the market several years later. Though fluoride can come from a number of sources, drinking water is the main source for Americans, researchers say.

Officials lowered their recommendation for drinking water fluoride levels in 2015 to address a tooth condition called fluorosis, that can cause splotches on teeth and was becoming more common in U.S. kids.

Separately, the Environmental Protection Agency has maintained a longstanding requirement that water systems cannot have more than 4 milligrams of fluoride per liter. That standard is designed to prevent skeletal fluorosis, a potentially crippling disorder which causes weaker bones, stiffness and pain.

But more and more studies have increasingly pointed to a different problem, suggesting a link between higher levels of fluoride and brain development. Researchers wondered about the impact on developing fetuses and very young children who might ingest water with baby formula. Studies in animals showed fluoride could impact neurochemistry cell function in brain regions responsible for learning, memory, executive function and behavior.

In 2006, the National Research Council, a private nonprofit organization in Washington, D.C., said limited evidence from China pointed to neurological effects in people exposed to high levels of fluoride. It called for more research into the effect of fluoride on intelligence.

After more research continued to raise questions, the National Toxicology Program in 2016 started working on a review of the available studies that could provide guidance on whether new fluoride-limiting measures were needed.

There were earlier drafts but the final document has repeatedly been held up. At one point, a committee of experts said available research did not support an earlier draft’s conclusions.

“Since fluoride is such an important topic to the public and to public health officials, it was imperative that we made every effort to get the science right,” said Rick Woychik, director of the National Toxicology Program, in a statement.

Malin said it makes sense for pregnant women to lower their fluoride intake, not only from water but also from certain types of tea. It might also make sense to have policy discussions about whether to require fluoride-content on beverage labels, she said.

___

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

IUDs, or intrauterine devices, are an increasingly popular form of long-term birth control in the United States. 

The insertion of an IUD — a small T-shaped device that is placed in the uterus — can be painful. As TikTok has grown in popularity, so too have videos of people detailing their experiences of getting an IUD, describing cramps, bleeding and passing out, sometimes even making videos in the exam room. 

The CDC’s new guidance, published earlier this month, includes a new recommendation: patients should be counseled on pain management before the procedure.

Because they are more than 99% effective in preventing pregnancy, the challenge for doctors is helping individuals who want an IUD to manage the pain, said Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital in Boston.

“A lot of us have recognized that historically, women’s pain has not been adequately addressed, that we’re trying to be much more cognizant of pain that patients feel during procedures,” Bartz said. 

The updated guidelines also expand options for pain management for the first time since 2016. That year, the agency recommended as an option a lidocaine injection into the cervix as an option to numb the area and reduce pain. This latest update expanded that to include topical lidocaine, in the form of gels or sprays. 

This, however, only targets a part of the pain felt during an IUD procedure.

Why are IUD insertions painful and what can help?

IUD insertions begin with a pelvic exam, after which the health care provider accesses the cervix using a speculum, the same tool used in pap smears. Next, a tool called a tenaculum is used to hold the cervix in place while the provider measures the depth of the uterus and then inserts the IUD. 

The insertion process itself usually takes under three minutes. 

Depending on the person, pain is felt differently throughout the procedure, but doctors say that measuring the depth of the uterus and inserting the IUD often causes an intense cramp. 

However, much of the scrutiny — and solutions — focus on the tenaculum, the medieval-looking device with two hooked ends that holds the nerve-heavy cervix in place as the uterus is measured and the IUD is inserted. 

Bartz said this portion of the procedure can cause discomfort, but it’s usually not the most painful part.

Swiss medical device company Aspivix has developed a new tool, called the Carevix, intended to replace the tenaculum and cause less pain. It was cleared by the Food and Drug Administration in early 2023 and uses a suction method to grasp the cervix instead of pincer-like forceps.

Results from a study conducted in Switzerland run by the company suggested the Carevix may decrease pain and bleeding for some patients, and another clinical trial is currently underway in the U.S., led by researchers at Indiana University.

Aspivix already has a warehouse and manufacturing plan ready for a commercial rollout before the end of 2024, said Ikram Guerd, the company’s U.S. managing director. Right now, it’s partnered with about a dozen clinics, mostly private and university hospitals, to “soft-launch” its product.  

Dr. Beverly Gray, an OB-GYN at Duke Health in Durham, North Carolina, said she’s curious to try any new device, as long as it’s as effective as the current tools. But she cautioned that no current solution will erase pain for all patients.

Even lidocaine, as recommended in the CDC guidelines to ease pain, has limits. 

“The numbing or the anesthetic medication is not like a silver bullet,” Gray said. “It is not something that universally helps everyone’s pain experience.”

Bartz said that lidocaine injections can be painful and noted that, in her experience, local anesthetic really only helps with tenaculum-related pain. Evidence is ambiguous on whether lidocaine injections or gels relieve cramps from placement itself. 

Doctors say they’re working from a limited toolbox.

Currently, the only options to target placement cramps are through nonsteroidal anti-inflammatory drugs like ibuprofen or conscious sedation, neither of which the CDC included in its recommendations. 

“The standard for me is to recommend ibuprofen, which was not discussed in the CDC guidelines, 600 or 800 milligrams — sort of a whopping dose at least a half hour prior to the procedure is most apt to help with cramping,” said Dr. Susan Reed, a gynecologist at UW Medicine in Seattle.

When doctors do recommend ibuprofen before the procedure, some women may think their concerns aren’t being taken seriously.

Alessa Rodriguez, 37, held off on getting an IUD for three years because of the pain. Part of that process, she said, involved finding a gynecologist who was willing to answer her questions and validate her decision. 

“I remember I had a long piece of paper of just question after question — trying to understand what exactly is the kind of pain I’m feeling?” Rodriguez, of New York City, said. “I understand that it’s different for everybody, but I didn’t want somebody to just say, take ibuprofen.”

In underserved areas where contraceptive care is scarce, available options to manage pain may be fewer.

“Definitely higher resourced settings are more equipped,” said Dr. Kerry Caputo, a complex family planning fellow at Northwestern University’s Feinberg School of Medicine.

“A lack of good options”

The CDC guidelines rely on existing research, which often isn’t there yet for contraceptive pain. 

“That’s the million-dollar question to me,” Reed said. “Do we do enough research in women’s health in general? The answer is absolutely not.”

Updating the guidelines is a multiyear process. Dr. Antoinette Nguyen, a medical officer in the CDC’s Division of Reproductive Health, said the group constantly monitors new research, then determines what is significant enough to issue a recommendation. 

Amid a lack of research, Dr. Aaron Lazorwitz, a complex family planning specialist and professor at the Yale School of Medicine, said gynecologists feel like they’re missing a piece of a puzzle.

“It’s been very frustrating in our field, the lack of good options,” Lazorwitz said. “We’re trying to find new tools that we can use because right now the tools are just not adequate enough.”

Taking pain counseling seriously

Pain during gynecological procedures can intersect with experiences of discrimination, trauma and anxiety, which is why doctors say an individualized conversation is so crucial. 

“To hear from so many women that they weren’t getting vital information even before stepping into the room was discouraging and disheartening,” Rodriguez said. She eventually got an IUD and felt side effects for months, but said it was the one of the best choices she’s ever made.

Nguyen said the new CDC guidelines capture this more expansive view of pain, but acknowledged clinical trials are limited and can’t speak to every experience.

Madeline Morcelle, a senior attorney at the National Health Law Program, a legal and civil rights advocacy nonprofit, said discrimination and “coercive practices” over pain management are baked into the health care system. She’s not surprised at the public outcry over IUD pain being dismissed by doctors, especially for marginalized groups.

Even if doctors have limited tools, counseling is non negotiable, Morcelle said.

While the CDC’s guidelines aren’t binding, Morcelle said continuing to deny pain counseling — especially if providers selectively issue pain management based on identity — could violate anti-discrimination measures in the Affordable Care Act.

“I think there is an argument to be made that refusals to counsel patients about pain management options for IUD insertion, or refusals to provide access to an evidence-based pain management option as supported in the CDC guidelines that were just issued last week, could be a form of prohibited sex discrimination,” Morcelle said.

Newer generations of gynecologists are taught to take pain seriously, Lazorwitz said, but only after centuries of ignorance in the medical profession. If a doctor dismisses pain concerns, he said it’s time to find someone new.

Many providers said pain counseling is already routine in their offices. Dr. Aparna Sridhar, an OB-GYN at UCLA Health in Los Angeles, said counseling should come naturally to well-trained doctors.

“I think having CDC’s recommendation makes it more of a validation of good practice,” Sridhar said. “But any doctor, if a procedure is known to be painful, it’s only a matter of logic and common sense and our caring ability that makes us think, ‘should we be offering something for pain?’”

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

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Eli Lilly’s highly popular weight loss drug reduced the risk of developing Type 2 diabetes by 94% in obese or overweight adults with prediabetes compared with a placebo, according to initial results from a long-term study released Tuesday. 

The late-stage trial on tirzepatide, the active ingredient in the company’s weight loss injection Zepbound and diabetes drug Mounjaro, also found that patients experienced sustained weight loss over the roughly three-year treatment period. Adults on the highest weekly dose of the drug saw a 22.9% decrease in body weight on average after 176 weeks, compared with 2.1% for those who received a placebo. 

The results suggest that Eli Lilly’s treatment could meaningfully delay a potential diagnosis for people with prediabetes, or those with blood sugar levels that are higher than normal but not high enough to be classified as Type 2 diabetes. 

More than 1 in 3 Americans have prediabetes, according to the latest government data, which health experts say can be reversed with lifestyle changes such as diet and exercise. People who are overweight or have obesity are at a higher risk for prediabetes. 

The new data also shows the potential long-term health benefits of taking a buzzy class of obesity and diabetes medications called GLP-1s, which mimic hormones produced in the gut to tamp down appetite and regulate blood sugar. As Eli Lilly’s Zepbound and Mounjaro and injections from rival Novo Nordisk have skyrocketed in popularity over the last two years, the companies have raced to study other clinical uses for their drugs.

“Obesity is a chronic disease that puts nearly 900 million adults worldwide at an increased risk of other complications such as Type 2 diabetes,” Dr. Jeff Emmick, senior vice president of product development at Eli Lilly, said in a statement. “These data reinforce the potential clinical benefits of long-term therapy for people living with obesity and pre-diabetes.”

Eli Lilly tested tirzepatide in more than 1,000 adults over 176 weeks in the phase three trial, followed by a 17-week period where patients stopped treatment. It is the longest completed study on the drug to date, according to the company. 

The drugmaker will submit the latest results to a peer-reviewed journal and present them at an upcoming medical conference in November. Eli Lilly published 72-week weight loss results on a larger group of patients from the same trial, called SUMOUNT-1, back in 2022. 

Patients in the trial who stopped taking tirzepatide during the 17 weeks began to regain weight and saw an increase in progression to diabetes. But those participants still had an 88% lower risk of developing diabetes compared with a placebo, according to the latest phase three results.

The safety data on tirzepatide during the trial was consistent with previous studies on the drug, according to Eli Lilly. The most common side effects were gastrointestinal, such as diarrhea, nausea, constipation and vomiting, and were generally mild to moderate in severity.

Eli Lilly’s Zepbound works by imitating two naturally produced gut hormones called GLP-1 and GIP. 

GLP helps reduce food intake and appetite. GIP, which also suppresses appetite, may also improve how the body breaks down sugar and fat.

Mpox, formerly known as monkeypox, is a viral infection characterized by painful lesions. It’s spread by direct contact with an infected person, animal or contaminated items like clothing or bedding.

The virus is classified into two distinct groups: clade I and clade II. 

Clade II was responsible for the 2022 outbreak, which has led to around 100,000 cases worldwide. 

But now, a version of clade I has spread internationally. The outbreak started in January 2023 in the Democratic Republic of Congo, and has since reached 12 other countries in the region.

On Thursday, Sweden confirmed the first known infection of clade I outside Africa, though Swedish health officials said the person was infected while spending time in Africa. Health authorities in Pakistan also confirmed a case of mpox on Friday but have not identified the strain yet. 

Clade I is more transmissible than clade II and capable of being more severe, so infectious disease experts are concerned about further international spread.

“We should have learned a lesson from 2022 that an infection anywhere is potentially an infection everywhere,” said Anne Rimoin, an epidemiology professor at the University of California, Los Angeles Fielding School of Public Health.

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How does this version of mpox spread?

Mpox has historically spread in a few ways. The first is through close, personal contact with an infected person, such as skin-to-skin contact with rashes or with saliva or mucus. The second is via contact with contaminated materials. And the third is contact with infected animals: hunting, trapping or cooking them, touching sick rodents or getting bitten or scratched. 

In 2022, the version of clade II that spread globally, dubbed clade IIb, was passed primarily through sexual contact, particularly among men who have sex with men.

In the Democratic Republic of Congo recently, clade Ib has also been spreading through sexual contact among female sex workers and men who have sex with men. Research that hasn’t yet been published or peer reviewed linked an outbreak in an eastern mining town in Congo to professional sex work in bars.

But that’s not the only way the virus is being transmitted. Dr. Stuart Isaacs, an associate professor of medicine at the University of Pennsylvania, said much of the spread of clade I could be due to exposure to animals and transmission within households, but limited surveillance in the regions where the virus is make it difficult to know for sure. 

Isaacs said there’s early evidence that clade Ib has certain “properties that are allowing it to spread more readily person to person.”

How severe are the recent cases?

In the past, outbreaks of clade I have been deadlier than clade 2, killing up to 10% of people who got sick. But more recent outbreaks have had lower death rates. Out of an estimated 22,000 cases in this outbreak in Congo, more than 1,200 people have died — which puts the fatality rate at just above 5%. 

By comparison, clade II outbreaks in Africa have generally had a mortality rate of around 1%, and just 0.2% of cases linked to the 2022 global outbreak were fatal.

Rimoin said the disease’s severity “can have less to do with the actual clade and more to do with route of transmission, the immune system of the individual, the source of the infection.” 

The threat in the U.S. could be milder than in Africa, according to Marc Siegel, an associate professor of medicine at the George Washington School of Medicine and Health Sciences.

“The underlying health conditions of the population in the DRC are probably contributing to the current case fatality rate,” he said, using the acronym for the Democratic Republic of Congo. “With less malnutrition and better access to health care resources, I would imagine that the case fatality rate will not be as high as we’re seeing in the DRC.”

Vaccines for mpox are also widely available in the U.S., following a major rollout effort in 2022. Two doses of the mpox vaccine or a previous clade II infection should protect against severe illness from clade I, the Department of Health and Human Service said Wednesday.

Do mpox symptoms differ between the clades?

Symptoms of the two mpox clades can be difficult to distinguish from each other.

The illness generally starts with a rash that progresses to small bumps on the skin, followed by blisters that fill with whitish fluid — a hallmark of the disease — and eventually scab over. People may also experience a fever, headache, muscle aches, back pain, low energy and swollen lymph nodes.

These symptoms often disappear on their own within a few weeks. But in severe cases, people may develop larger, more widespread lesions, secondary bacterial infections, pneumonia, heart inflammation or swelling of the brain. Immunocompromised people may develop atypical symptoms and have a greater risk of hospitalization and death. 

Historically, mpox lesions have tended to appear on the face, chest, palms of the hands and the soles of the feet. But during the 2022 outbreak, people frequently developed lesions around the genital and anal region or inside the mouth and throat, presumably because of how the virus was spreading at the time. The lesions were also fewer in number and less pronounced overall.

Some cases of this nature have also been detected in the current outbreak in Congo. 

“There is talk that there are more people that have lesions around the genitals this time around than previous clade I outbreaks,” said Amira Albert Roess, a professor of global health and epidemiology at George Mason University. “It’s going to take us some time to really understand what may be going on here.”

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School absences surged during the pandemic and have yet to recover. Nearly 1 in 4 students remains chronically absent, defined as missing 10% or more of the academic year, according to the latest data analyzed by The Associated Press.

One reason for continued high absences: After years of COVID-19 quarantines, parents are more cautious about sending children to school when they might be contagious with an illness.

When a child misses school, even for an excused absence like a sick day, it’s harder for them to stay on track academically. So schools and health experts are trying to change the culture around sick days.

Here’s what they want parents to know.

COVID guidelines have changed

During the pandemic, the Centers for Disease Control and Prevention urged people who tested positive for COVID-19 to isolate at home for a set number of days and to quarantine after exposure to the coronavirus. In some settings, people with any mild illness were urged to remain home until symptoms were clear.

Those standards, and the caution behind them, remained for years after schools reopened to in-person instruction. That meant children often missed large portions of school after contracting or being exposed to COVID-19 or other illnesses.

This spring, COVID-19 guidance officially changed. Now, the CDC suggests people treat COVID-19 like other respiratory illnesses, such as the flu and RSV.

Fever-free for 24 hours

If a child has a fever, they should stay home, no matter the illness.

A child can return to school when their fever has been gone for 24 hours without fever-reducing medication. Other symptoms should be improving.

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What about other symptoms?

If a child doesn’t have a fever, it’s OK to send them to class with some signs of illness, including a runny nose, headache or cough, according to schools and the American Academy of Pediatrics. If those symptoms aren’t improving or are severe, such as a hacking cough, call your child’s doctor.

The guidance around vomiting and diarrhea varies across school districts. Generally, students should remain home until symptoms stop, according to American Academy of Pediatrics guidelines. Older children may be able to manage mild diarrhea at school.

“Unless your student has a fever or threw up in the last 24 hours, you are coming to school. That’s what we want,” said Abigail Arii, director of student support services in Oakland, California.

Guidance from the Los Angeles Unified School District says students can attend school with mild symptoms such as a runny nose or cold, but should stay home if they have vomiting, diarrhea, severe pain or a fever of 100 degrees Fahrenheit (37 degrees Celsius) or higher.

School districts across the U.S. have similar guidance, including in Texas, Illinois and New York.

When to wear a mask

The CDC says people should take additional precautions for five days after returning to school or other normal activities.

Masks and social distancing are no longer mandated but are encouraged to prevent disease spread. Experts also recommend plenty of handwashing and taking steps for cleaner air, such as opening a window or running an air purifier.

School districts say parents should keep up-to-date on all health examinations and immunizations for students so they don’t miss additional days of school.

___

AP Education Writer Jocelyn Gecker in San Francisco contributed.

If you’re taking on more than you can handle, your body may warn you that burnout is on the horizon.

However, burnout isn’t exactly a mental health diagnosis, says Molly Burrets, a licensed clinical psychologist.

“It’s more of a chronic condition that happens when we experience chronic fatigue [and] overwhelm when the demands of our life exceed our capacity to meet those demands,” she tells CNBC Make It, adding that it can increase your likelihood of experiencing mental health conditions like depression and anxiety.

Spotting the signs of burnout is key for preventing it, or reversing it. Burrets says the symptoms of burnout come in three categories: physical, emotional and behavioral.

Here’s what to watch out for:

How your body tells you that you’re on the verge of burnout

1. Physical symptoms

“Some of the most common physical symptoms are things like chronic fatigue or insomnia, difficulty either falling or staying asleep,” Burrets says.

Additional physical symptoms that can indicate you’re burnt out may include:

• Frequent headaches
• Muscle pain
• Digestive issues
• Weakened immune system

2. Emotional symptoms

The emotional indicators of burnout tend to be the signs that are most commonly associated with the phenomenon. “These are ones that people are often most primed to notice and understand indicate a real problem,” Burrets says.

Those symptoms include:

• Increased irritability
• Experiencing a loss of motivation, even to do things that bring you joy
• Feeling detached or emotionally drained
• Increased frustration
• Having negative feelings about work or caregiving responsibilities

3. Behavioral symptoms

Look out for shifts in your behavior that are likely being used as coping mechanisms, Burrets says. Some of the most common behavioral symptoms include overeating, binge drinking or increased drug use.

But behavioral symptoms can also manifest as:

• Procrastination
• Withdrawal from social responsibilities
• Isolation from others
• Lower levels of productivity, especially at work

“If you notice that you are having behavioral symptoms, emotional symptoms and physical health symptoms, that’s a red flag,” Burrets says. “You are burnt out by that point.”

How to reverse burnout

Before setting out to tackle your burnout symptoms, Burrets recommends consulting with your doctor to make sure they aren’t the result of other, underlying health conditions.

Once you’ve done that, Burrets recommends reducing your work load to make time for more self care.

She recommends trying out some of the following:

• Exercise and physical activity
• Quality time with friends and family
• A new hobby
• Meditation
• Mindfulness activities

Before you add anything else to your plate, she says it’s important to “look at the demands on your time and ask yourself, what can be removed” — with a minimal impact on your life.

Though it may be hard to reduce your responsibilities and re-think your priorities, Burrets says sacrifice is necessary in order to improve your well-being.

The goal is to “take some things off our plate that are inessential and perhaps add in some self care activities in place of those, or just more downtime, more rest and relaxation.”

Making these tough choices, Burrets says, are ultimately essential for recovery. “We have to have boundaries in order to prevent burnout.”

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The question “What is a thought?” is no longer strictly a philosophical one. Like anything else measurable, our thoughts are subject to increasingly technical answers, with data captured by tracking brainwaves. That breakthrough also means the data is commodifiable, and captured brain data is already being bought and sold by companies in the wearable consumer technologies space, with few protections in place for users. 

In response, Colorado recently passed a first-in-the-nation privacy act aimed at protecting these rights. The act falls under the existing “Colorado Consumer Protection Act,” which aims to protect “the privacy of individuals’ personal data by establishing certain requirements for entities that process personal data [and] includes additional protections for sensitive data.” 

The key language in the Colorado act is the expansion of the term “sensitive data” to include “biological data” — inclusive of numerous biological, genetic, biochemical, physiological, and neural properties.

Elon Musk’s Neuralink is the most famous example of how technology is being embedded with the human mind, though it isn’t alone in the space, with Paradromics emerging as a close competitor, alongside devices that have returned speech to stroke victims and helped amputees move prosthetic limbs with their minds. All of these products are medical devices that require implantation, and are protected under HIPAA’s strict privacy requirements. The Colorado law is focused on the rapidly growing consumer technology sphere and devices that don’t require medical procedures, have no analogous protections, and can be bought and used without medical oversight of any kind. 

There are dozens of companies making products that are wearable technologies capturing brain waves (aka neura data). On Amazon alone, there are pages of products, from sleep masks designed to optimize deep sleep or promote lucid dreaming, to headbands promising to promote focus, and biofeedback headsets that will take your meditation session to the next level. These products, by design and necessity, capture neural data through use of small electrodes that produce readings of brain activity, with some deploying electric impulses to impact brain activity. 

The laws in place for the handling all of that brain data are virtually non-existent.   

“We have entered the world of sci-fi here,” said lead sponsor of the Colorado bill, Representative Cathy Kipp. “As with any advances in science, there must be guardrails.”

‘ChatGPT-moment’ for consumer brain tech

A recent study by The NeuroRights Foundation found that of thirty companies examined who are making wearable technology that is capable of capturing brainwaves, twenty-nine “provide no meaningful limitations to this access.” 

“This revolution in consumer neurotechnology has been centered on the increasing ability to capture and interpret brainwaves,” said Dr. Sean Pauzauskie, medical director at The NeuroRights Foundation. Devices using electroencephalography, a tech readily available to consumers, is “a multibillion-dollar market that is set to double over the next five or so years,” he said. “Over the next two to five years it is not implausible that neurotechnology might see a ChatGPT-moment.”

How much data can be collected depends upon several factors, but the technology is rapidly advancing, and could lead to an exponential increase in applications, with the tech increasingly incorporating AI. Apple has already filed patents for brain-sensing AirPods.

“Brain data are too important to be left unregulated. They reflect the inner workings of our minds,” said Rafael Yusuf, professor of biological sciences and director, NeuroTechnology Center, Columbia University, as well as Chairman of the NeuroRights Foundation and leading figure in the neutotech ethics organization Morningside Group. “The brain is not just another organ of the body,” he added. “We need to engage private actors to ensure they adopt a responsible innovation framework, as the brain is the sanctuary of our minds.”

Pauzauskie said the value to companies comes in the interpretation or decoding of the brain signals collected by wearable technologies. As a hypothetical example, he said, “if you were wearing brain-sensing earbuds, not only would Nike know that you browsed for runners’ shoes from your browsing history, but could now know how interested you were as you browsed.”  

A wave of biological privacy legislation may be needed

The concern targeted by the Colorado law may lead to a wave of similar legislation, with heightened attention to the mingling of rapidly-advancing technologies and the commodification of user data. In the past, consumer rights and protections have lagged behind innovation.

“The best and most recent tech/privacy analogies might be the internet and consumer genetic revolutions, which largely went unchecked,”  Pauzauskie said.

A similar arc could follow unchecked advancements in the collection and commodification of consumer brain data. Hacking, corporate profit motives, ever-changing privacy agreements for users, and narrow to no laws covering the data, are all major risks, Pauzauskie said. Under the Colorado Privacy Act, brain data is extended the same privacy rights as fingerprints.

According to Professor Farinaz Koushanfar and Associate Professor Duygu Kuzum of the department of Electrical and Computer Engineering at UC San Diego, it is still too early to understand the limitations of the technology, as well as the depths of the potentially intrusive data collection.

Tracking neural data could mean tracking a broad range of cognitive processes and functions, including thoughts, intentions, and memories, they wrote in a joint statement sent via email. At one extreme, tracking neural data might mean accessing medical information directly. 

The broad range of possibilities is itself an issue. “There are too many unknowns still in this field and that’s worrisome,” they wrote.

If these laws become widespread, companies may have no choice but to overhaul their current organizational structure, according to Koushanfar and Kuzum. There may be a need for establishing new compliance officers, and implementing methods such as risk assessment, third-party auditing and anonymization as mechanisms for establishing requirements for the entities involved.

On the consumer side, the Colorado law and any subsequent efforts represent important steps toward better educating users, as well as giving them the required tools to check and exercise their rights should they be infringed. 

“The privacy law [in Colorado] regarding neurotechnology might stand as a rare exception, where rights and regulations precede any widespread misuse or abuse of consumer data,” Pauzauskie said.

It’s a major milestone in the Biden administration’s push to reduce the skyrocketing costs of prescription drugs in the U.S. But there’s a lot to still work out, including the burning question: Will older adults see the savings at all if drugmakers succeed in having the negotiations blocked by the courts?

“Lower prescription drug prices are hugely popular among the public, but the future is uncertain,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “The pharmaceutical industry and its allies have filed an avalanche of litigation against the price negotiations.”

So far, courts have summarily rejected the legal challenges.

Who benefits from lower prices?

More than 65 million people in the U.S. are enrolled in Medicare. Most people won’t see direct savings until the prices go into effect in 2026.

The Biden administration said Thursday that it negotiated price cuts of between 38% and 79% for each of the 10 drugs that cost the program the most money.

This includes Eliquis, a popular blood thinner from Bristol Myers Squibb, which carried a list price of $521 for a 30-day supply in 2023; Enbrel, a rheumatoid arthritis drug from Amgen, with a 2023 list price of $7,106; and NovoLog, a diabetes medication from Novo Nordisk, priced at $495.

More than 8 million Medicare enrollees are taking one or more the negotiated drugs, Tricia Neuman, senior vice president of KFF, a nonprofit group that researches health policy issues, said.

It’s difficult to estimate how much the federal government is going to save the enrollees and American taxpayers. Biden administration officials declined to disclose the net price — the amount Medicare typically pays for prescription drugs after all discounts and rebates. (The net prices negotiated between insurers and drugmakers often involve confidentially agreements.)

Still, the administration projects that the negotiated prices will save older adults $1.5 billion in out-of-pocket costs, as well as $6 billion for the Medicare program — a 22% reduction in total net spending, said Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee.

Implementing the new pricing for Medicare Part D plans will take time, as it affects what patients, the government and the plans, will pay.

“You’re making a complete renovation of these different components of the benefit,” Dusetzina said.

How much savings will Medicare enrollees get?

When the prices do go into effect, the seniors who will likely see the most savings are those whose Medicare Part D plan requires them to pay a percentage of the total cost of the drug before discounts, also known as coinsurance, Neuman said. This is different from a copay, which is a fixed amount — for example, $10 — for a medication regardless of its total cost.

“People who take these drugs are expected to see savings, but the amount is going to vary from plan to plan, and whether or not they’re in a plan that charges a coinsurance versus a copayment,” Neuman said. 

Most Medicare enrollees may not “save a great deal,” especially if they’re taking one of the 10 selected drugs, Gostin said, but the lower prices could result in lower premiums for everyone.

“To me, the most important benefits of the drug pricing negotiations are that lower drug costs will filter down to benefit everything with lower prices,” he said.

What about the $2,000 prescription price cap?

Currently, the savings apply only to those taking one of the 10 drugs, but that’s likely to change. 

As mandated by the Inflation Reduction Act (IRA) the federal government can negotiate lower prices on several more drugs each year.

In 2027, negotiated prices will go into effect for 15 more drugs, followed by another 15 drugs in 2028 and 20 more in each subsequent year. It’s likely more seniors could save significantly more in the next few years.

By February, the government is expected to announce the next 15 drugs up for negotiation.

Still, people might not have to wait until 2026 or 2027 for relief. A $2,000 annual cap on out-of-pocket prescription drug costs, included in the IRA, begins next year.

“That’s the next big change coming,” Dusetzina said. “It’s important to realize that 2025’s benefit change will have already improved the situation for seniors, so that by the time the negotiated prices go into effect, it might not change the cost to people who use the medications more, but it will help everyone who uses Medicare Part D.”

Many people not even reach the $2,000 out of pocket cap, Neuman said, but that’s OK. 

“Just the idea of not having to pay more than $2,000 is a huge relief because you never know when you’re going to be prescribed a really expensive drug,” she said. 

Affordable drugs ‘hangs in the balance’

There’s a risk all of this could get upended if drugmakers succeed in their lawsuits to overturn the Medicare negotiation program, Gostin said.

That’s because savings from the Medicare negotiation program are what is expected to pay for much of the $2,000 out-of-pocket cap. Currently, the cap is said to be covered by other provisions in the IRA — such as a rebate on drugmakers who raise the price of their drugs faster than inflation — and Medicare and drug manufacturers taking on more of the cost.

According to the Health Care Litigation Tracker from Georgetown University, more than a dozen lawsuits have been filed to overturn the law. A handful have already been dismissed by the courts, but several are still ongoing.

“Ultimately, these cases will come before the Supreme Court, which has been hostile to health and safety regulation,” Gostin said.

Another factor to consider is the possibility of former President Donald Trump winning the upcoming presidential election, Neuman said.

Trump’s position on the IRA and the Medicare negotiation provision remains unclear, Neuman said.

However, she noted that one of the goals of Project 2025 is to repeal the law.

Project 2025 is a sweeping collection of right-wing ideas to transform the U.S. government. Though it was written by former Trump officials in anticipation of a second term, Trump has said he knows “nothing” about it.

“If President Trump wins the election, he might dismantle the price negotiation program,” Gostin said. “All in all, the future of affordable drugs for all Americans hangs in the balance.”

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Pertussis illness, known as whooping cough, is caused by a bacteria that spreads from person to person through the air, the Fairfax County Health Department said. Whooping cough spreads more easily when people spend a lot of time together or share breathing space.

What are the symptoms of whooping cough?

At first, the illness can seem like a common cold, with symptoms including a runny or stuffed-up nose, low fever and mild cough, health officials said.

Those symptoms can last one to two weeks before some people who catch whooping cough develop coughing fits, which can last weeks to months, the health department said.

During these coughing fits, people might:

• make a high-pitched “whoop” sound when they breathe in after a coughing fit
• vomit during or after coughing fits
• feel tired after the fit, but seem well in-between fits
• have trouble sleeping at night
• struggle to breathe
• fracture a rib from coughing too hard

Babies might not cough at all, but instead gasp for air or have pauses in breathing, or apnea, which is life-threatening. Apnea can cause the baby to turn blue, and about one in three babies younger than a year old who get whooping cough need care in the hospital, officials said.

People with weakened immune systems or with moderate or severe asthma are also at a higher risk of getting very sick from whooping cough.

How can I keep myself and my family from getting whooping cough?

The health department said the best way to avoid whooping cough is to get vaccinated.

Two types of vaccines protect against it: DTaP and Tdap. They also protect against diphtheria and tetanus.

Here’s what health officials recommend:

• Children should get five doses of DTaP, including at least one dose on or after their 4th birthday.
• Preteens 11 to 12 years old should get a booster dose of Tdap before they start 7th grade.
• Adults should get a booster dose of Tdap every 10 years and during every pregnancy.

Bekele, from Fairfax, Virginia, is being recognized for developing an affordable bar of soap that could make delivering medications for skin cancers, including melanoma, more accessible.

Melanoma is the most invasive type of skin cancer with the highest risk of death, according to Cleveland Clinic. However, it is highly curable, if caught early.

“It’s absolutely incredible to think that one day, my bar of soap will be able to make a direct impact on somebody else’s life,” the 15-year-old told Time. “That’s the reason I started this all in the first place.”

Bekele’s passion for science started at an early age. He conducted his first science experiment when he was just 4 years old, mixing together any household products he could get his hands on and seeing what would happen. He advanced to a chemistry set when he was 6. A few years ago, he decided to tackle skin cancer.

Some of Bekele’s earliest memories were of seeing laborers work under the searing heat with no heat protection in Ethiopia, where Bekele was born, according to Time. After emigrating to the U.S., the young scientist said he realized what a “big problem the sun and ultraviolet radiation is when you’re exposed to it for a long time.”

Then, Bekele learned about imiquimod, a cream-based drug that can help destroy tumors. While effective, the drug can be expensive, often being prescribed as part of a treatment plan that can cost $40,000. Imiquimod’s retail price can go up to $180 without insurance, and is even more expensive in Ethiopia.

Bekele realized a bar of soap could be an effective, accessible and cost-saving delivery system for the drug.

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To turn this idea into reality, Bekele applied to — and won — 3M’s Young Scientist Challenge in 2023, securing $25,000 and the title of “America’s Top Young Scientist.” With the help of Johns Hopkins professor and molecular biologist Vito Rebecca, Bekele has been testing the soap on lab mice at the university’s lab for almost half a year.

“[His idea] immediately piqued my interest, because I thought, how cool, him wanting to make it accessible to the whole world,” Rebecca said to Time.

The soap still has a long way to go: Testing, patenting it and getting FDA certification could take a decade. But even then, Bekele will only be 25 years old. Most medical school students don’t graduate until they are 28.

Bekele is only going into his sophomore year at Woodson High School in Fairfax this year. Still, he is incredibly humble.

“Anybody could do what I did,” Bekele said. “I just came up with an idea. I worked towards that idea, and I was able to bring it to life.”

Doctors are trying to figure out why it’s becoming increasingly common: Colorectal cancer rates among younger people are rising by 1% to 2% every year.

It’s a lesser-known and less-funded cancer, which is why one survivor is sharing his story – in hopes that his ordeal can help save someone else.

Survivor only noticed 1 symptom of his colorectal cancer

For Jeff Harris, a diagnosis of stage-three colorectal cancer at just 40 came as a huge surprise.

The husband and father of two was shocked because he showed almost no signs of serious illness – except one concerning symptom that is common among colon cancer patients.

“I felt fine. I had rectal bleeding one day. That was significant and was something… I was like, ‘That’s not good,’” he said.

A colonoscopy showed a large mass on his colon.

“Time kind of stood still,” he recalled.

He soon went in for surgery, which revealed his cancer wasn’t just in his colon.

“Woke up from surgery and my surgeon said, ‘Well, everything was fine, except it was more in your rectum than it was your colon. So, it was kind of just kind of both. Rectosigmoid junction,” he said, referring to a zone where the rectum and colon meet.

After surgery came chemotherapy. He did 10 rounds of infusions, 28 rounds of radiation and oral chemotherapy. Today, his scans show no evidence of disease.

‘Alarming’: Why are colorectal cancers becoming more common?

Harris is not alone. He’s met many folks much younger than him – even in their late 20s and early 30s – who have colorectal cancer.

“Some of them, you know, aren’t with us today. So, it’s alarming,” he said.

John Marshall, the chief medical officer at Lombardi Comprehensive Cancer Center, is among doctors trying to figure out why colorectal cancer rates are on the rise among younger people.

The leading theory relates to the bacteria that grow in the mouths and guts of all humans. Everyone has their own “microbiome” made up of bacteria and other microbes that can be helpful or harmful to their health.

“We evolved over time to include bacteria in our mouths and our GI [gastrointestinal] tracts. Think of it as your own personal soil,” Marshall said. “So, our leading theory is: Just like we’re changing our air and we’re changing our water with the world around us, we are probably also changing the world inside of us, our own microbiome.”

Colorectal cancers show up in different locations than colon cancers.

“They’re all in that bottom part of the question mark of the colon,” Marshall said. “Whereas normal, older colon cancer can be seen anywhere throughout the colon.”

Colorectal cancer symptoms and screening: ‘Don’t worry about the colonoscopy’

According to the Colorectal Cancer Alliance, the most common symptom is no symptom at all.

Colorectal cancer symptoms could include blood in your stool, a change in bowel habits, abdominal pain, weakness or fatigue and weight loss.

“There’s still stigma around it because people don’t want to talk about colons, rectums, poops and all that,” Harris said.

It’s important to talk about the signs of colorectal cancer. Reluctance to talk about a sensitive area of the body can slow the process of getting diagnosed and treated.

Routine screenings can help identify potential cancer in earlier stages when it’s easier to treat. Doctors may even be able to remove concerning polyps – small tissue growths – before they turn cancerous, according to the American Cancer Society.

Doctors say everyone should begin screenings for colon cancer when they’re 45, regardless of whether they have symptoms or not. People who have a family history of the disease or other risk factors should get screenings even earlier in life.

Screenings can be done with a traditional colonoscopy, but there are less invasive options.

“I will tell anybody that has any kind of symptoms. Get it checked out. Don’t worry about the colonoscopy. It’s not bad. Colonoscopy is a walk in the park compared to cancer treatment,” Harris said.

Dr. Marshall says it’s important to figure out what’s going on – and figure it out fast.

The Colorectal Cancer Alliance has advice on how to talk to your doctor about screenings. There’s also information on financial help for people who can’t afford screenings.

Colorectal cancer prevention

Dr. Marshall says the colorectal cancer trend is scary. His best advice?

“It really comes back to a Mediterranean diet. A little less meat. It’s not evil, but less of it. Lots of fruits, nuts, little coffee chaser. And keep moving, keep exercising,” he said.

Other lifestyle changes that can help include minimizing processed foods.

Fundraiser planned in Potomac, Maryland

In 2022, Harris rang the hospital bell marking that he’s cancer-free. Since then, he’s shown no evidence of disease.

Now, he is focused on living, spreading the word and fundraising.

The Colorectal Cancer Alliance is hoping to raise much-needed funds to research the disease.

They’re holding the first-ever Contactors Against Cancer golf tournament on Aug. 25-26, 2024, at Avenel Farm in Potomac, Maryland. Edwin McCain and Ryan Cabrera will be part of the two-day event. Here’s more information.

Your body’s natural response to this intense heat is to try and self-regulate – to keep your body from overheating.

This is especially true when the temperature climbs above 100 degrees. Your body has to work harder to maintain an internal temperature of around 98.6 degrees.

Your body regulates its temperature through sweating and increasing blood flow to the skin. These processes force your body to exert extra energy. Hence, you may feel tired and lethargic, without even having done much.

Medical experts use the term “vasodilation” as a way the body responds in an attempt to regulate its temperature.

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This bodily response is when blood vessels dilate as a way of releasing heat. Since wider, dilated blood vessels can result in lower blood pressure, this can further contribute to that feeling of sluggishness or fatigue.

In addition, our sleep can get disrupted in hot weather, especially if a comfortable temperature indoors cannot be attained. Of course, a lack of sleep can have a carryover effect the next day.

Other contributors to feeling tired during the summer can be dehydration, decreased appetite, and overall heat stress on the body.

It’s important to recognize the signs of heat stress or worse, heat stroke, which is a medical emergency.
While most of us aren’t on the edge of heat stroke, it’s vital to be aware of these symptoms and always listen to your body. Take note of all the signs of heat-related illness below.

In conclusion, the sluggishness we experience is a way our bodies are telling us to slow down and take it easy, especially during the hottest part of the day.

Now, I don’t know about you, but I’m ready for a nap!

In January, Elmo had asked X users a seemingly innocent question: “Elmo is just checking in! How is everybody doing?” — only to be met with declarations of “existential dread,” mental burnout and general disenchantment with daily life.

The dreary responses inspired Sesame Workshop, the nonprofit behind “Sesame Street,” to undertake a survey project focusing on the “state of well-being in America.”

Conducted in partnership with consulting and market research firm The Harris Poll, “The State of Well-Being Report” interviewed 2,012 members of the U.S. population ages 16 and older in May. The survey was published Tuesday.

When asked about what they prioritize when it comes to the future of well-being, the majority of the participants found mental health nearly as important as economic stability, according to the findings.

“We could not have predicted the overwhelming response that followed Elmo’s post,” Samantha Maltin, chief marketing and brand officer of Sesame Workshop, said in a news release, adding that the Muppet’s post drew millions of responses. “As Elmo’s viral moment and this new study indicate, the most pressing issue facing American families right now is mental health and emotional well-being.”

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A third of parents and half of teens also said mental health issues significantly affect their well-being, with many parents citing lack of access to high-quality education and consequences of the Covid-19 pandemic as sources of negative impact.

Other common stressors on well-being reported in the survey include physical health, the effects of climate change, lack of a strong network of friends or family, and racism or discrimination.

When Elmo’s innocent question went viral in January, the official X account for “Sesame Street” shared a link to mental health resources.

Aaron Bisman, the vice president of audience development at Sesame Workshop, told NBC News at the time that “leveraging the interest in Elmo’s tweet” to share resources for emotional well-being is “exactly what Sesame Workshop was created to do.”

Despite all the apparent doom and gloom online, the survey also reported a glimmer of hope for the next generation of Americans: 67% of those interviewed said they wish their parents had been more honest about their own mental health struggles, including 79% of parents.

A majority of Gen Z and millennials — as well as 71% of educators surveyed — also said that they believe schools “should focus on social and emotional skills just as much as academics.”

While there appears to be a significant gap between the percentage of participants who believe they themselves practice kindness (93%) and those who believe the average American is kind (55%), a vast majority of people surveyed said it’s important to promote kindness in society.

In an appearance in February on NBC’s “TODAY” show, Elmo shared a message of empathy and urged people to check in on their friends.

“It’s important to remember that we all have a lot of feelings, and that’s OK,” the furry red Muppet said. “It’s good to know what feeling you’re having, and if you’re feeling sad or worried or confused, then you have to talk to someone that you love and trust, and it’s good to talk about it.”

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The school nurse, who had been seeing students with “really rosy, red cheeks,” suggested Parks might have the same infection.  

“I got progressively sicker,” she said. “I was in bed with a fever for four or five full days.”

When blood tests given by her OB-GYN came back positive for parvovirus B19 in early May, she was referred to a maternal fetal medicine specialist. The doctor discovered the virus had passed to the fetus in utero. The fetus had developed anemia, a very dangerous condition. Doctors gave the fetus a blood transfusion in utero. 

Cases of parvovirus B19 — more commonly known as Fifth disease or “slapped cheek syndrome” because of the red rash that covers an infected patient’s face — are rising in the U.S. On Tuesday, the Centers for Disease Control and Prevention issued an alert to doctors to watch for signs of the highly contagious seasonal virus. 

Most of the infections are among children ages 5 to 9, the CDC said. Since March, parvovirus has been circulating in Europe at unusually high rates, according to the European Centre for Disease Prevention and Control. 

Most adults have already had the infection as kids and are still protected. However, the CDC warned that pregnant people and people with sickle cell disease who have never been exposed are at risk of serious illness.  

Parks’ doctor, Kathy Bligard, an OB-GYN at Washington University Hospital in St. Louis, said: “Abby is not the only patient whose fetus has needed a blood transfusion in the last few months for parvovirus. It’s certainly something that I used to see maybe once every other year and have seen multiple times in the last few months.”

Bligard said parvovirus is dangerous to pregnant women because it can cross the placenta and infect the fetus and cause it to be anemic, which could lead to fetal death.

Parks has recovered from the virus, but her pregnancy is still at risk.

On Wednesday morning, after an ultrasound showed the fetus wasn’t receiving enough blood from the placenta, Parks was admitted to a hospital in Springfield to care for the baby.

“I do think it was lifesaving for the fetus,” Parks said about the earlier transfusion. “Because if that anemia had persisted, with that low blood count, the baby could have died,” Parks said in an interview Wednesday from her hospital bed.

Bligard said the virus makes it harder for a fetus to make new red blood cells. “In order to get oxygen to all of the important organs in our body, our body relies on having those red blood cells. And so it can cause heart failure or even progression to death by having low blood counts.”

Although the disease affects mostly children, when adults do catch it, it can cause more severe symptoms, including joint pain and anemia, which result from problems in creating red blood cells, said Dr. Vincent Iannelli, a pediatrician in the Dallas area. Low red blood cell counts can cause pregnancy complications.

Patients with sickle cell disease are also at high risk.

“Over the past month or two, I think we’ve been seeing more cases,” Iannelli said. Typically Iannelli would see one case of Fifth disease per month; he said he’s now seeing one to two cases per week, noting that the virus is more common in the spring and summer.

What are symptoms of Fifth disease? 

In children, Fifth disease is typically mild — its most distinctive symptoms include a fever and respiratory symptoms, followed by a red rash on the cheeks, then a “lacy” rash on the rest of the body, which may be itchy.

The rash appears toward the end of the infection and typically disappears in seven to 10 days, but it may last for several weeks. Importantly, someone with Fifth disease is no longer contagious once the rash appears. “Unfortunately, by the time you know your kid has it, they’re not contagious anymore,” Iannelli said.

The rash can become more pronounced in heat and sunlight, but it doesn’t make the infection worse, Iannelli said.

Pregnant women who experience symptoms like joint pain and problems in producing red blood cells should notify their doctors immediately, especially if they know they have been in contact with patients infected with Fifth disease, doctors say.

Iannelli doesn’t believe the rise in cases is cause for alarm.

“Fortunately, most pregnant women had it when they were kids, so they’re immune to it, but every once in a while we do see adults,” he said. 

Ultimately, “if you’re healthy, it’s a mild disease,” Iannelli said. “If you have immune system problems or if you’re pregnant, early in your pregnancy you should tell your doctor. But for everybody else, it’s basically just a rash.”

He noted that the CDC alert was intended to raise awareness among doctors, not to concern the public.

Why is it called Fifth disease?

In the early 1900s, doctors developed a list of common childhood rashes to help them be more precise in their diagnoses. They identified six major rashes:

• Measles, a highly contagious virus that can cause rash, high fever and respiratory symptoms.
• Scarlet fever, a bacterial infection caused by group A streptococcus. 
• Rubella, a viral infection also known as German measles. If someone is exposed during pregnancy, the virus can cause miscarriage or stillbirth. The CDC recommends two doses of the mumps-measles-rubella vaccine for children. 
• Filatov-Dukes, no longer considered a distinct disease. 
• Fifth Disease, or parvovirus B19, also known as erythema infectiosum.
• Roseola, a viral infection occasionally still called Sixth disease, which can cause high fever and rash. 

There are now more recognized childhood rashes, such as chickenpox, so the numbering system isn’t used anymore, except for Fifth disease.

At the hospital, Parks, now at 30 weeks, is being monitored closely. She wants other pregnant women to be aware of the virus and get tested if they have been exposed.

“It has been truly the most difficult experience to go through,” Parks said. “He wasn’t guaranteed to come through the fetal anemia.”

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