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  • Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN

    Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN

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    CNN
     — 

    Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.

    Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.

    What they didn’t expect was that it would take hours to find a bed for her.

    Even though the respiratory surge that overwhelmed doctor’s offices and hospitals last fall is over, some parents like Schnacky are still having trouble getting their children beds in a pediatric hospital or a pediatric unit.

    The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.

    But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.

    “There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.

    The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.

    By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.

    “This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”

    The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.

    “In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.

    Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.

    As Covid-19 tore through Southern California, small hospitals in rural towns like Apple Valley were overwhelmed, with coronavirus patients crammed into hallways, makeshift ICU beds and even the pediatric ward.

    Only 37% of hospitals in the US now offer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.

    While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.

    The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.

    In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.

    “Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.

    In July, Tufts Medical Center in Boston converted its 41 pediatric beds to treat adult ICU and medical/surgical patients, citing the need to care for critically ill adults, the health system said.

    In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.

    “Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.

    Registered nurses at Tufts Medical Center hold a

    Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.

    The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.

    The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.

    Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.

    Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.

    “Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”

    Pediatric gastroenterologist Dr. Howard Baron visits with a patient in 2020 in Las Vegas. A large portion of his patients are on Medicaid with reimbursement rates that are far below private insurers.

    Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.

    More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.

    At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.

    “Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.

    And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.

    “There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”

    Low insurance reimbursement rates also factor into how hospital administrations make financial decisions.

    “When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.

    “Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a] lower, more difficult payment environment in general, are going to find it especially hard.”

    Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.

    A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.

    Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.

    “These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”

    Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.

    Steve Inglish, left, and registered nurse Nikole Hoggarth, middle, help a father with his daughter, who fell and required stiches, inside the emergency department at Jamestown Regional Medical Center in rural North Dakota in 2020.

    “It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.

    In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.

    “That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”

    When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.

    “I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”

    Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.

    “My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”

    Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are staying in emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.

    It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.

    Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.

    “There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.

    When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.

    “For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.

    “If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”

    Dr. Susan Wu, right, chats with a child who got her first dose of the Pfizer-BioNtech Covid-19 vaccine at Children's Hospital Arcadia Speciality Care Center in Arcadia, California, in 2022.

    So, what can be done to improve access to pediatric care? Much like the reasons behind the difficulties parents and caregivers are experiencing, the solutions are complex:

    • A lot of it comes down to money

    Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.

    “People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”

    Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.

    • Increased access to children’s mental health services

    With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.

    “How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.

    There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.

    “If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”

    Most experts CNN spoke to agreed: Seek care for your child early.

    “Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”

    Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.

    “Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.

    Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.

    “A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.

    Jaimie and Effie Schnacky now have an asthma action plan after the 7-year-old's hospitalization in February.

    After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.

    It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.

    “We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”

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  • Bindi Irwin reveals 10-year battle with endometriosis on International Women’s Day | CNN

    Bindi Irwin reveals 10-year battle with endometriosis on International Women’s Day | CNN

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    CNN
     — 

    The Australian conservationist Bindi Irwin revealed Wednesday she has undergone surgery for endometriosis after a decade-long battle with the condition that affects the uterus.

    “For 10 years I’ve struggled with insurmountable fatigue, pain and nausea,” Irwin shared in posts on social media alongside an image of her in a hospital bed.

    “A doctor told me it was simply something you deal with as a woman and I gave up entirely, trying to function through the pain.”

    Irwin’s posts coincided with both International Women’s Day and Endometriosis Awareness Month.

    Endometriosis is “a condition in which the tissue that normally lines the uterus grows outside the uterus,” according to the United States’ National Institutes of Health.

    Symptoms can include pelvic pain, heavy bleeding during periods and fertility issues.

    Irwin, 24, said doctors had found 37 lesions, some of which were “very deep and difficult to remove,” but she was now “on the road to recovery.”

    “I’m sharing my story for anyone who reads this and is quietly dealing with pain and no answers. Let this be your validation that your pain is real and you deserve help,” she added.

    Anyone with a uterus who is of reproductive age can suffer from the disease but it’s most common among women in their 30s and 40s. Approximately one in 10 people born with a uterus has endometriosis, according to the World Health Organization. The disease affects around 190 million women and girls globally.

    Irwin is a celebrity conservationist who has starred in “Crikey! It’s the Irwins,” a reality TV show that chronicles her family’s work at the Australia Zoo in Queensland, which her mother owns.

    She won “Dancing With the Stars” in 2015 and comes from a family of conservationists that includes her father Steve, the late ‘Crocodile Hunter’ who was killed by a stingray while filming in the Gerat Barrier Reef in 2006.

    She gave birth to a daughter, Grace, in March 2021.

    “Please be gentle and pause before asking me (or any woman) when we’ll be having more children,” Irwin wrote in her post Wednesday. “After all that my body has gone through, I feel tremendously grateful that we have our gorgeous daughter. She feels like our family’s miracle.”

    Soon after her posts, her family took to social media to share their support.

    Her husband Chandler Powell said, “Seeing how you pushed through the pain to take care of our family and continue our conservation work while being absolutely riddled with endometriosis is something that will inspire me forever.”

    Irwin’s brother Robert added on Instagram that, “You never know who’s suffering in silence, let’s make this a topic that we all freely talk about.”

    Irwin is the latest in a series of celebrities to have opened up about their struggles with endometriosis.

    In a Paramount Plus docuseries released last year, comedian Amy Schumer discussed her decades-long battle with what she called a “lonely disease.” Schumer had her uterus removed in 2021 and shared video on her Instagram following the surgery.

    Comedian Lena Dunham and actress Padma Lakshmi have also been vocal about their experiences with the disease.

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  • There’s a new Reese’s in town, hold the dairy | CNN Business

    There’s a new Reese’s in town, hold the dairy | CNN Business

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    New York
    CNN
     — 

    Vegan Reese’s are happening.

    Hershey, which makes Reese’s along with Hershey bars, Kisses and other chocolates and candies, announced two new dairy-free products on Tuesday: Reese’s plant-based peanut butter cups, and a vegan chocolate Hershey bar with almonds and sea salt, each made with oats instead of dairy and designed to taste like milk chocolate. The new Reese’s variety will be available nationally this month, and the new Hershey bar is arriving in April.

    The company is the latest to introduce a vegan chocolate in hopes that it will attract more customers. But Hershey is a little late to the game.

    Nestlé

    (NSRGY)     introduced KitKat V, a vegan version of the chocolate bar, in 2021. Mondelez

    (MDLZ)     acquired Hu, a company which makes vegan chocolate, that year, as well. Hershey also initiated a test of a version of its product in 2021.

    In prepared remarks discussing the company’s fourth-quarter results, CEO Michele Buck said that “better for you,” which includes plant-based items, presented an opportunity for the company and will “receive greater levels of support this year.”

    “We are excited to introduce these delicious, plant-based options,” Teal Liu, brand manager of Better For You at Hershey

    (HSY)    , said in a statement announcing the launch Tuesday, adding that the new products offer more options for “chocolate lovers looking for plant-based alternatives.”

    By focusing on vegan alternatives to milk chocolate, specifically, Hershey may have a better chance of setting its products apart from others in the market.

    “As the vegan chocolate space gets more crowded, claims beyond plant-based may be necessary,” Kelsey Olsen, consumer insights analyst for food & drink at market research firm MIntel, told CNN in an email. “While many plant-based items previously launched have been dark chocolate varieties, brands should explore the areas of plant-based milk chocolate and white chocolate.”

    Touting oat as an ingredient could also help.

    Confectioners “can take advantage of oat milk’s unique properties to appeal to a larger consumer base, whether vegan or not,” Olsen said.

    Chocolate as a category has been resilient in the past few years, with people reaching for treats during the stress of the early pandemic and seeing it as a relatively affordable splurge even as prices rise.

    But it’s not clear that an oat-based chocolate will do the trick. “The majority of consumers are not focused on added [better for you] components to chocolate,” Olsen noted in a Mintel report last year.

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  • Texas sued by women who say state’s abortion bans put their health at risk | CNN Politics

    Texas sued by women who say state’s abortion bans put their health at risk | CNN Politics

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    CNN
     — 

    Several women who say Texas’ abortion bans posed significant risks to their health have sued the state this week, opening a new front in the legal battles that have emerged since the Supreme Court overturned national abortion rights protections last year.

    Five women allege in the lawsuit that uncertainty around when medical emergency exemptions in Texas’ abortion laws apply exacerbated medical emergencies that put their lives, health and fertility in danger.

    “To the extent Texas’s abortion bans bar the provision of abortion to pregnant people to treat medical conditions that pose a risk to the pregnant person’s life or a significant risk to their health,” the lawsuit says, “the Bans violate pregnant people’s” rights under the state constitution’s provisions protecting fundamental rights and the right to equality.

    The lawsuit is not seeking to block Texas’ abortion bans outright. Rather, the women – who are joined by two medical providers in the lawsuit – ask the court to clarify that abortions can be performed when a physician makes a “good faith judgment” that “the pregnant person has a physical emergent medical condition that poses a risk of death or a risk to their health (including their fertility).”

    The women’s complaint details harrowing stories of being denied abortion care when they faced emergency complications in their pregnancies, which were all wanted. They filed the lawsuit in state court in Austin, Texas.

    Texas, its Attorney General Ken Paxton, the Texas Medical Board and its Executive Director Stephen Brint Carlton are listed as defendants in the lawsuit. Neither Paxton’s office nor a spokesperson for the state medical board responded to a request for comment from CNN. Gov. Greg Abbott’s office also did not immediately respond to CNN’s inquiry.

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  • Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

    Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

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    CNN
     — 

    Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

    Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

    Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

    “I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

    Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

    Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

    For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

    All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

    The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

    The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

    But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

    In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

    The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

    “The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

    In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

    “The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

    Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

    Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

    “I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

    He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

    “It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

    “Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

    There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

    “Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

    Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

    “I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

    In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

    “The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

    Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

    “We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

    Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

    “Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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  • NFL star Aaron Rodgers went to a darkness retreat to contemplate his future. What is that and how does it work? | CNN

    NFL star Aaron Rodgers went to a darkness retreat to contemplate his future. What is that and how does it work? | CNN

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    CNN
     — 

    For four days this week, home for Green Bay Packers quarterback Aaron Rodgers was a pitch-black room. There were no phones, no television, no lights or distractions. Just Rodgers, alone with his thoughts, in a cabin built specifically for prolonged isolation in the dark.

    When the four-time NFL MVP announced plans earlier this month to contemplate his NFL future in isolation at a “darkness retreat,” many were left scratching their heads.

    “It’s just sitting in isolation, meditation, dealing with your thoughts,” Rodgers said earlier this month. “We rarely even turn our phone off or put the blinds down to sleep in darkness. I’m really looking forward to it.”

    Rodgers is no stranger to alternative therapies. He credits psychedelics like psilocybin and ayahuasca for helping to alleviate his fear of death and deepening a sense of self-love. The football star said he has done “many meditation and yoga retreats” in the past and defended his decision to try darkness therapy as one of several practices “that have stimulated my mind and helped me get in a better headspace and have a greater peace in my life.”

    But what exactly happens in a darkness retreat? And is it just another new-age fad or perhaps something that could benefit the rest of us?

    A darkness retreat is exactly what it sounds like: a prolonged stay in a space completely devoid of light. One of the centers offering the practice is Sky Cave Retreats, nestled in the Cascade-Siskiyou wilderness, in Southern Oregon, near Klamath Falls.

    “The reasons for doing this range from people wanting to know themselves more, to people who want to rest, reset and relax, to those who want to explore consciousness and deepen their meditation practice,” said Scott Berman, who owns Sky Cave Retreats along with his wife Jill, adding the darkness helps illuminate what really matters by stripping away the constant bombardment of sensory input and stimulation many people experience in their hectic modern lives.

    “When someone goes into the darkness, all these things that were important to them like money, fame, power, status, being worthy – they all become insignificant and meaningless in the dark,” Berman said. “In the dark, all you have is the present moment which reveals what is truly meaningful – whether it’s love, forgiveness, peace – and it begins to transform you as you truly authentically touch what is most important to you.”

    The center currently operates three stand-alone cabins built specifically for prolonged isolation in the dark – earth-sheltered caves, which on the outside are somewhat reminiscent of a Hobbit home. Each space contains a bed, a toilet, sink and a bathtub, as well as a low table for eating and a carpeted area for yoga and meditation. Participants can leave at any time – the doors are never locked – and there is a light switch for emergencies which is protected by a childproof guard so it isn’t flipped on by accident.

    The cost includes three meals a day, which Berman delivers personally all at once in the evening (through a lightproof double-sided food box) to minimize the disturbance. This is when participants have an opportunity for a conversation, which could be 10 seconds or 30 minutes, according to Berman, depending on the person’s needs.

    Participants typically spend three to four days in the darkness at a cost of $250 a night and are encouraged to take an extra day before and after to integrate the experience.

    Each space contains a bed, a toilet, sink and a bathtub, as well as a low table for eating and a carpeted area for yoga and meditation.

    Burak Dalcik, a 27-year-old salesman from Arlington, Virginia, said the four days he spent in the dark at Sky Caves Retreats in January gave him clarity about his priorities. He found he no longer labeled experiences as positive or negative, but rather allowed them to come and to go, which led to less stress and anxiety at work and in his personal life. He also said he started calling his mom, who lives back in Turkey, more frequently.

    “It just really trims all the unnecessary fat and allows you to focus on some of the most important things and really allows you to understand who you are,” said Dalcik. “There’s nothing New Age about this – it boils down to can you just sit by yourself with yourself? And if you can’t, you should probably get pretty curious about why.”

    Berman cautions the retreat isn’t for everyone, nor should it be seen as a quick fix to one’s troubles.

    “It’s not like this magical, mind-blowing, amazing experience – it can be extremely difficult and uncomfortable,” Berman said. “But in the darkness, discomfort is the door to transformation. There’s an acceptance and a profound love that people start to experience when they’re no longer resisting that part of themselves.”

    For now, there is limited research on how darkness retreats impact the human brain and body. Some centers claim the experience can help heal traumas or activate the pineal glad, another claim is darkness therapy increases melatonin production in the brain.

    “That’s totally false,” said Dr. David Blask, the head of the Laboratory of Chrono-Neuroendocrine Oncology at Tulane University School of Medicine. “There may be some psychological benefits that people derive from a darkness retreat that they feel are important for them, but certainly not from a strict endocrine neuroendocrine or biochemical physiological standpoint.”

    Dr. Marek Malůš, a psychologist at the University of Ostrava in the Czech Republic who has been studying darkness therapies since 2010, sees the technique as a promising therapeutic tool.

    “Your thoughts, memories, emotions, inner world and mental processes become much more balanced and integrated,” Malůš said.

    While he and his colleagues are working to secure funding for additional studies, Malůš said preliminary research showed just four days in a darkness chamber was enough to help increase mindfulness and self-esteem, lower symptoms of depression and anxiety, while improving parasympathetic nervous system functions, which helps with stress management and lowering burnout symptoms. Subjects reported feeling the benefits three weeks after the experience.

    Berman said he hopes to see more scientific research into the benefits of darkness retreats, but cautions against anyone seeking to use the retreat for some sort of natural high.

    “If somebody’s coming here because they want to have a so-called DMT experience, you’ve come into the wrong place,” he said. “But there is a lot of benefit in not looking outside of ourselves for confirmation of our worth and using the darkness to illuminate our true nature.”

    For those who aren’t able to commit the time or money for a darkness retreat but want a taste of some of the benefits, Berman suggests starting small at home.

    “It’s about becoming accustomed to authentically slowing down, putting the phone away, turning out the lights, closing the blinds and just resting,” he said. “Not to get somewhere, not to heal but just to be curious about what’s actually happening within yourself.”

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  • Strengthen your core with exercises you can do at home using only a paper plate | CNN

    Strengthen your core with exercises you can do at home using only a paper plate | CNN

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    Editor’s Note: Dana Santas, known as the “Mobility Maker,” is a certified strength and conditioning specialist and mind-body coach in professional sports, and is the author of the book “Practical Solutions for Back Pain Relief.”



    CNN
     — 

    With spring still nearly a month away, the continued wintry weather and shorter days with less sunlight could be taking a toll on your motivation to get out and exercise. Understandably, you may be inclined to skip the gym in favor of staying cozy inside. But don’t let the winter blues keep you from moving your body!

    By getting creative, you can get the exercise you need at home not only to boost your physical health but also to increase the feel-good brain chemicals serotonin, dopamine and noradrenaline to help you beat those doldrums.

    There are lots of ways you can work out in the comfort of your home quickly and simply — without expensive gym equipment. With a little ingenuity, broom handles, backpacks and other everyday household items can serve as useful tools during your workout. If you have access to stairs, there are numerous exercises you can do using just two stairs. Even a paper plate can be used for exercise.

    That’s right, just a single paper plate can provide all the means necessary for a surprisingly challenging total-body workout that strengthens your core and improves your balance. It may sound far-fetched, so I’ve outlined the exercises below and included an instruction video at the top of this article so you can try it for yourself.

    Important note: Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

    Perform eight to 10 repetitions of each exercise on each side of your body while maintaining a focus on good form and being able to breathe well. The instability of the paper plate is what creates the challenge. In each exercise, the side of your body that’s not using the paper plate is the stabilizing side, so that side will feel the burn of working harder to maintain balance.

    If you struggle with strength or balance limitations, start off by practicing the movements using the suggested modifications for each exercise.

    Place one foot on the paper plate and slide that leg back into a lunge position, bending your knee to gently tap it on the floor, if possible. The forward leg should also bend into a lunge position with your knee aligned above your ankle.

    Use the strength of your core and stabilizing front leg to return to standing. That’s one rep. Go through all reps on one side and then repeat on the other side.

    How to modify: Decrease how far back you slide and place a hand on a wall if balance is an issue.

    From a standing position, put one foot on the paper plate and perform a slide-out lateral lunge by sliding your foot out to the side while taking a half-squat position with your opposite leg. Keep your chest up, trying not to lean forward too much.

    As you perform a slide-out lateral lunge, focus on the standing leg that's stabilizing your movements and keep your chest high.

    Use the strength of your core and stabilizing leg to return to standing. Go through all reps on one side and then repeat on the other side.

    How to modify: If you aren’t strong enough to hold the half-squat position, you can put a chair under your hip to sit back on as you slide out your opposite leg. Place a hand on a wall if you need help with balance.

    From a plank position on the floor with your feet positioned a little wider than hip distance apart to help with counterbalance, place one of your hands on the paper plate. Maintaining a strong core and neutral spine, make circles with the plate on the floor.

    From a plank position, use the plate to make circles on the floor while keeping a strong core and neutral spine.

    Go as wide as your shoulder mobility will allow while still being able to stabilize. After making four circles in one direction, go in the other direction for another four circles. Switch to the other side and repeat the pattern of four circles in each direction.

    How to modify: If you feel your back arching, lower to your knees to make it a bit easier to engage your core and keep a neutral spine.

    From a plank position with your feet a little wider as noted above, place the toes of one foot on the paper plate. Just like you did with the shoulder circles, use your hip mobility to draw circles with your foot.

    Use your hip mobility to draw circles with your foot — just as you did with the shoulder circles.

    Make four circles in one direction and four in the other direction, then repeat with the other leg.

    How to modify: You can lower to the knee of your stabilizing leg if you have difficulty maintaining a neutral spine. If you struggle to make a circular motion, try a mountain climber forward-back motion instead.

    Try a mountain climber forward-back motion if you have trouble making a circular motion.

    Depending on your current fitness level and how you feel while doing these exercises, do the four exercises sequentially through three to five rounds. You might be surprised by how exhausted you can get using just a paper plate! Be sure to take short breaks in between rounds to drink some water and catch your breath.

    To help you overcome the winter blues and strengthen your body — especially your core, I recommend doing this workout a few times per week. Once spring arrives, look for more opportunities to exercise outside.

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  • Rihanna tells us she’s pregnant in the most entertaining way | CNN

    Rihanna tells us she’s pregnant in the most entertaining way | CNN

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    CNN
     — 

    Rihanna didn’t introduce a new song during her Apple Music Super Bowl LVII Halftime Show performance Sunday night but she did introduce a new pregnancy.

    The entertainer sang a medley of her biggest hits while visibly pregnant with her second child, her representative has confirmed to CNN.

    Online speculation about the pregnancy began as Rihanna opened her performance in Glendale, Arizona, on a floating stage wearing an all-red ensemble that appeared to show off a baby bump.

    Last May, Rihanna welcomed her first child with rapper A$AP Rocky.

    The singer spoke about motherhood during an interview as she prepared for her halftime show performance, saying becoming a mother made her feel like she can do anything.

    “When you become a mom, there is something that just happens where you feel like you can take on the world,” said the musical icon and entrepreneur.

    “The Super Bowl is one of the big stages in the world, so as scary as that was – because I haven’t been on stage in seven years – there’s something exhilarating about the challenge of it all,” said Rihanna, who last toured in 2016. “It’s important for me to do this this year. It’s important for representation. It’s important for my son to see that.”

    The pregnancy didn’t appear to slow Rihanna down during the performance break from the Kansas City Chiefs and Philadelphia Eagles showdown. She danced and belted out some of her best-known hits, surrounded by a crew of dancers dressed in white. She opened the show with “B**ch Better Have My Money,” before moving on to other entries on her long list of chart toppers, including, “We Found Love,” “Rude Boy,” “Work,” “Only Girl (In the World)” and “Umbrella.”

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  • I tried Microsoft’s new AI-powered Bing. Here’s what it’s like | CNN Business

    I tried Microsoft’s new AI-powered Bing. Here’s what it’s like | CNN Business

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    Seattle
    CNN Business
     — 

    Microsoft’s Bing search engine has never made much of a dent in Google’s dominance in the more than 13 years since it launched. Now the company is hoping some buzzy artificial intelligence can win converts.

    Microsoft on Tuesday announced an updated version of Bing designed to combine the fun and convenience of OpenAI’s viral ChatGPT tool with the information from a search engine.

    Beyond providing a list of relevant links like traditional search engines, the new Bing also creates written summaries of the search results, chats with users to answer additional questions about their query and can write emails or other compositions based on the results. With the new Bing, for example, users can create trip itineraries, compile weekly meal plans and ask the chatbot questions when shopping for a new TV.

    This is the new era of search that Microsoft

    (MSFT)     — which is investing billions of dollars in OpenAI — envisions, one where users are accompanied by a sort of “co-pilot” around the web to help them better synthesize information. The company is betting on the new technology to drive users to Bing, which had for years been an also-ran to Google Search. Microsoft

    (MSFT)     also announced an updated version of its Edge web browser with the new Bing capabilities built in.

    The event comes as the race to develop and deploy AI technology heats up in the tech sector. Google on Monday unveiled a new chatbot tool dubbed “Bard” in an apparent bid to keep pace with Microsoft and the success of ChatGPT. Baidu, the Chinese search engine, also said this week it plans to launch its own ChatGPT-style service.

    The updated Bing and Edge launched to the public on a limited basis on Tuesday, and are set to roll out to millions of people for unlimited search queries in the coming weeks. I took Bing for a spin at a press event at Microsoft’s Redmond, Washington, headquarters Tuesday.

    The tool provides the sort of immediate gratification we now expect from the internet — rather than clicking through a bunch of links to suss out the answer to a question, the new Bing will do that work for you. But it’s still early days for the technology, which Microsoft says is still evolving.

    The homepage of the new Bing feels familiar: you can type a query into the search bar and it returns a list of links, images and other results like a typical search engine. But on the left side of the page are written summaries of the results, complete with annotations and links to the original information sources. The search field allows up to 2,000 characters, so users can type the way they’d talk, rather than having to think of the few correct search terms to use.

    Users can also click over to a “chat” page on Bing, where a chatbot can answer additional questions about their queries.

    I asked Bing to write me a five-day vegetarian meal plan. It returned a list of vegetarian meals for breakfast, lunch and dinner for Monday through Friday, such as oatmeal with fresh berries and lentil curry. I then asked it to write me a grocery list based on that meal plan, and it returned a list of all the items I’d need to buy organized by grocery store section.

    Based on my request, the Bing chatbot also wrote me an email that I could send to my partner with that grocery list, complete with a “Hi Babe” greeting and “XOXO” closing. It’s not exactly how I’d normally write, but it could save me time by giving me a draft to edit and then copy and paste into an email, rather than having to start from scratch.

    The generated portions of Bing have personality. When you ask the chatbot a question, it responds conversationally and sometimes with emojis, letting you know it’s happy to help or that it hopes you have fun on the trip you’re planning.

    With the new Edge browser, I asked the tool to summarize one of my articles, and then turn that into a social media post the length of a short paragraph with a “casual” tone that I could share on Twitter or LinkedIn.

    The new Bing is built in partnership with OpenAI — the company behind ChatGPT in which Microsoft has invested billions — on a more advanced version of the technology underlying the viral chatbot tool. Still, the new Bing has some of the quirks that the public version of ChatGPT is known for. For example, the same query may return different responses each time it’s run; this is in part just how the tool works, and in part because it’s pulling the most updated search results each time it runs.

    It also didn’t cooperate with some of my requests. After the first time it created a meal plan, grocery list and email with the list, I ran the same requests two more times. But the second and third time, it wouldn’t write the email, instead saying something like, “sorry, I can’t do that, but you can do it yourself using the information I provided!” The tool is also sensitive to the wording used in queries — a request to “create a vegetarian meal plan” provided information about how to start eating healthier, whereas “create a 5-day vegetarian meal plan” provided a detailed list of meals to eat each day.

    Even next-gen search technology isn’t immune to basic flubs. I can imagine using the tool ahead of an upcoming local election, to learn about who is running for office in my area, what their positions are and how and when to vote. But when I asked the chatbot, “when is the next election in Kings County, NY?” it returned information about the November election last year.

    The new Bing may also present some of the same concerns as ChatGPT, including for educators. I asked Bing’s chatbot to write me a 300-word essay about the major themes of the book “Pride and Prejudice” and, within less than a minute, it had pumped out 364 words on three major themes in the novel (although some of the text sounded a bit repetitive or wonky). Per my request, it then revised the essay as if it was written by a fifth grader.

    The chatbot tool has feedback buttons so users can indicate whether its answers were helpful or not, and users can also chat directly with the tool to tell it when answers were incorrect or unhelpful, the company says.

    “We know we won’t be able to answer every question every single time, … We also know we’ll make our share of mistakes, so we’ve added a quick feedback button at the top of every search, so you can give us feedback and we can learn,” Yusuf Mehdi, Microsoft’s vice president and consumer chief marketing officer, said in a presentation.

    With some controversial search topics, it appears the new Bing chatbot simply refuses to engage. For example, I asked it, “Can you tell me why vaccines cause autism?” to see how it would react to a common medical misinformation claim, and it responded: “My apologies, I don’t know how to discuss this topic. You can try learning more about it on bing.com.” The same query on the main search page returned more standard search results, such as links to the CDC and the Wikipedia page for autism.

    Likewise, it would not return a chatbot request for how to build a pipe bomb, instead saying in its answer, “Building a pipe bomb is a dangerous and illegal activity that can cause serious harm to yourself and others. Please do not attempt to do so.” However, one of the links provided in the annotation of its answer brought me to a YouTube video with apparent instructions for building a pipe bomb.

    Microsoft says it has developed the tool in keeping with its existing responsible AI principles, and made efforts to avoid its potential misuse. Executives said the new Bing is trained in part by sample conversations mimicking bad actors who might want to exploit the tool.

    “With a technology this powerful I also know that we have an even greater responsibility to make sure that it’s developed, deployed and used properly,” said responsible AI lead Sarah Bird.

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  • Trader Joe’s asked customers to rank their nine top products. Here they are | CNN Business

    Trader Joe’s asked customers to rank their nine top products. Here they are | CNN Business

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    New York
    CNN
     — 

    Trader Joe’s asked its customers a simple question: If you were to spend the rest of your life on a deserted island, which nine Trader Joe’s products would you take with you?

    More than 18,000 customers responded to its 14th annual survey ranking the grocery store’s most popular items in nine different categories.

    There were some caveats this year: Gone from the running were five products that have won many times in the past (think Mandarin Orange Chicken and dark chocolate peanut butter cups), and instead are featured in its Product Hall of Fame.

    The first Trader Joe’s opened in Pasadena, California, in 1967. Its founder Joe Coulombe (yes, Joe was a real guy), was a convenience store owner who wanted to open a grocery chain to appeal to a niche market of well-educated, well-traveled consumers. The idea led him to create a cult-favorite grocery empire.

    Here are the products customers voted their favorites, in categories from cheese to entrees.

    Chili & Lime Flavored Rolled Tortilla Chips, spicy corn chips, swept the competition this year, taking home the top prize. Runners-up included the hash browns, chicken soup dumplings, Everything but the Bagel sesame seasoning blend, and chocolate croissants.

    See the all-time favorites included in Trader Joe’s Hall of Fame

    The chips also won in the poll’s favorite snack category. Customers were also fans of the Organic Elote Corn Chip Dippers, Organic Corn Chip Dippers, World’s Puffiest White Cheddar Corn Puffs and Crunchy Curls, which were all among the top vote-getters.

    The Sparkling Honeycrisp Apple Juice was the fans’ favorite beverage, though it is seasonal. The canned drink is a simple three-ingredient blend of apple juice, water and bubbles.

    Following is the Triple Ginger Brew, Sparkling Peach Black Tea with peach juice, Sparkling Cranberry & Ginger Beverage and the Non-Dairy Brown Sugar Oat Creamer.

    Trader Joe's Cheddar Cheese with Caramelized Onions

    Now that Hall of Famer Unexpected Cheddar is no longer an option in the poll, the store’s cheddar cheese with caramelized onions took home top accolades.

    See the full list of customer choice award winners

    Runners-up included Syrah Soaked Toscano, seasonal Baked Lemon Ricotta, Blueberry & Vanilla Chèvre and its various bries.

    Replacing the longtime Mandarin Orange Chicken is Trader Joe’s Butter Chicken – spiced chicken in a tomato and cream sauce with basmati rice.

    Indian is popular with Trader Joe’s customers. Second runner-up was Chicken Tikka Masala, followed by Kung Pao Chicken, Butternut Squash Mac & Cheese and BBQ Teriyaki Chicken.

    Seasonal candles won out in this category. Its seasonal scents include Peony Blossom, Cedar Balsam, Honeycrisp Apple and Vanilla Pumpkin.

    Runners-up: Daily Facial Sunscreen, Ultra-Moisturizing Hand Cream, Tea Tree Tingle Shampoo & Conditioner, and Shea Butter & Coconut Oil Hair Mask.

    Unsurprisingly, customers voted bananas as their top choice. The chain is known for its 25-cent organic bananas and 19-cent regular bananas. Following choices were Teeny Tiny Avocados, Honeycrisp Apples, Brussels Sprouts and Organic Carrots of Many Colors.

    The tiny and crunchy Hold the Cone! Mini Ice Cream Cones won top dessert, followed by Danish Kringle, Sublime Ice Cream Sandwiches, Chocolate Lava Cakes and Brookie.

    Trader Joe's Vegan Kale, Cashew & Basil Pesto spread onto a grilled Portabella mushroom burger, topped with roasted red peppers and fresh greens

    Among its many vegan and vegetarian options, the Vegan Kale, Cashew & Basil Pesto came out on top. Vegetable Fried Rice, Beefless Bulgogi, Palak Paneer, Cauliflower Gnocchi followed.

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  • Why urgent care centers are popping up everywhere | CNN Business

    Why urgent care centers are popping up everywhere | CNN Business

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    New York
    CNN
     — 

    If you drive down a busy suburban strip mall or walk down a street in a major city, chances are you won’t go long without spotting a Concentra, MedExpress, CityMD or another urgent care center.

    Demand at urgent care sites surged during the Covid-19 pandemic as people searched for tests and treatments. Patient volume has jumped 60% since 2019, according to the Urgent Care Association, an industry trade group.

    That has fueled growth for new urgent care centers. A record 11,150 urgent care centers have popped up around the United States and they are growing at 7% a year, the trade group says. (This does not include clinics inside retail stores like CVS’ MinuteClinic or freestanding emergency departments.)

    Urgent care centers are designed to treat non-emergency conditions like a common cold, a sprained ankle, an ear infection, or a rash. They are recommended if patients can’t get an immediate appointment with their primary care doctor or if patients don’t have one. Primary care practices should always be the first call in these situations because they have access to patients’ records and all of their health care history, while urgent care sites are meant to provide episodic care.

    Urgent care sites are often staffed by physician assistants and nurse practitioners. Many also have doctors on site. (One urgent care industry magazine says, in 2009, 70% of its providers were physicians, but that the percentage had fallen to 16% by last year.) Urgent cares usually offer medical treatment outside of regular doctor’s office hours and a visit costs much less than a trip to the emergency room.

    Urgent care has grown rapidly because of convenience, gaps in primary care, high costs of emergency room visits, and increased investment by health systems and private-equity groups. The urgent care market will reach around $48 billion in revenue this year, a 21% increase from 2019, estimates IBISWorld.

    The growth highlights the crisis in the US primary care system. A shortage of up to 55,000 primary care physicians is expected in the next decade, according to the Association of American Medical Colleges.

    But many doctors, health care advocates and researchers raise concerns at the proliferation of urgent care sites and say there can be downsides.

    Frequent visits to urgent care sites may weaken established relationships with primary care doctors. They can also lead to more fragmented care and increase overall health care spending, research shows.

    And there are questions about the quality of care at urgent care centers and whether they adequately serve low-income communities. A 2018 study by Pew Charitable Trusts and the Centers for Disease Control and Prevention found that antibiotics are overprescribed at urgent care centers, especially for common colds, the flu and bronchitis.

    “It’s a reasonable solution for people with minor conditions that can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need constant management of a chronic illness, you should not go there.”

    Urgent care centers have been around in the United States since the 1970s, but they were long derided as “docs in a box” and grew slowly during their early years.

    They have become more popular over the past two decades in part due to pressures on the primary care system. People’s expectations of wait times have changed and it can be difficult, and sometimes almost impossible, to book an immediate visit with a primary care provider.

    Urgent care sites are typically open for longer hours during the weekday and on weekends, making it easier to get an appointment or a walk-in visit. Around 80% of the US population is within a 10-minute drive of an urgent care center, according to the industry trade group.

    “There’s a need to keep up with society’s demand for quick turnaround, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.

    Health insurers and hospitals have also become more focused on keeping people out of the emergency room. Emergency room visits are around ten times more expensive than visits to an urgent care center. During the early 2000s, hospital systems and health insurers started opening their own urgent care sites, and they have introduced strategies to deter emergency room visits.

    Additionally, passage of the Affordable Care Act in 2010 spurred an increase in urgent care providers as millions of newly insured Americans sought out health care. Private-equity and venture capital funds also poured billions into deals for urgent care centers, according to data from PitchBook.

    Urgent care centers can be attractive to investors. Unlike ERs, which are legally obligated to treat everyone, urgent care sites can essentially choose their patients and the conditions they treat. Many urgent care centers don’t accept Medicaid and can turn away uninsured patient,s unless they pay a fee.

    Like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services, or the patient pays out of pocket. In 2016, the median charge for a 30-minute new insured patient visit was $242 at an urgent care center, compared with $294 in a primary care office and $109 in a retail clinic, according to a study by FAIR Health, a nonprofit that collects health insurance data.

    “If they can make it a more convenient option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of health care policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the big bucks are in health care, but there’s a substantial number of patients.”

    Mehrotra research has found that between 2008 and 2015, urgent care visits increased 119%. They became the dominant venue for people seeking treatment for low-acuity conditions like acute respiratory infections, urinary tract infections, rashes, and muscle strains.

    Some doctors and researchers worry that patients with primary care doctors – and those without – are substituting urgent care visits in place of a primary care provider.

    “What you don’t want to see is people seeking a lot care outside their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, the urgent care medical director at the Lurie Children’s Hospital of Chicago.

    Burns’ research has found that high urgent care reliance fills a need for children with acute issues but has the potential to disrupt primary care relationships.

    The National Health Law Program, a health care advocacy group for low-income families and communities, has called for state regulations to require coordination among urgent care sites, retail clinics, primary services, and hospitals to ensure continuity of patients’ care.

    And while the presence of urgent care centers does prevent people from costly emergency department visits for low-acuity issues, Mehrotra from Harvard has found that, paradoxically, they increase health care spending on net.

    Each $1,646 visit to the ER for a low-acuity condition prevented was offset by a $6,327 increase in urgent care center costs, his research has found. This is in part because people may be going to urgent care for minor illnesses they would have previously treated with chicken soup.

    There are also concerns about the oversaturation of urgent care centers in higher-income areas that have more consumers with private health care and limited access in medically underserved areas.

    Urgent care centers selectively tend not to serve rural areas, areas with a high concentration of low-income patients, and areas with a low concentration of privately-insured patients, researchers at the University of California at San Francisco found in a 2016 study. They said this “uneven distribution may potentially exacerbate health disparities.”

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  • FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN

    FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN

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    CNN
     — 

    A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

    The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

    The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

    Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

    This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

    Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

    People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

    The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

    Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

    Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

    “The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

    Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

    Others feel that convenience is important but also stressed that data supported the switch.

    “This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

    Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

    “I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

    Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

    The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

    The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

    “The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

    “But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

    In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

    For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

    The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

    Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

    “We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

    The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

    One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

    Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

    Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

    Another puzzle will be how to pick the strains that are in the vaccines.

    The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

    “Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

    Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

    At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

    The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

    In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

    After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

    At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

    The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

    When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

    Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

    The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

    Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

    Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

    Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

    Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

    What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

    The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

    “I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

    Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

    The FDA confirmed that the agency is taking a closer look.

    “The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

    The FDA did not give a time frame for when these studies might have results.

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  • Opinion: Women don’t have to die from cervical cancer | CNN

    Opinion: Women don’t have to die from cervical cancer | CNN

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    Editor’s Note: Dr. Eloise Chapman-Davis is director of gynecologic oncology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine. Dr. Denise Howard is chief of obstetrics and gynecology at NewYork-Presbyterian Brooklyn Methodist Hospital and a vice chair of obstetrics and gynecology at Weill Cornell Medicine. The views expressed in this commentary are their own. Read more opinion on CNN.



    CNN
     — 

    As doctors who specialize in women’s reproductive health, we are on the front lines of a preventable crisis. Imagine treating a woman with advanced cancer who has a five-year survival rate of 17%, knowing that she should have never developed the deadly disease in the first place.

    This is what we are facing with cervical cancer. Yet we have the clinical tools not only to lower but also eliminate nearly all the roughly 14,000 new cases and 4,300 deaths from cervical cancer each year.

    Denise Howard

    We have effective screenings: the traditional Pap smear and the HPV test. If these screening tests are abnormal, additional tests can determine who needs further treatment to prevent the development of cancer. Importantly, we have the HPV vaccine, which protects against high-risk human papillomavirus (HPV) types that cause the majority of cervical cancer cases and is nearly 100% effective, according to the National Cancer Institute.

    A report published earlier this month shows the vaccine’s tremendous impact. The US saw a 65% drop in cervical cancer rates from 2012 through 2019 among women ages 20-24, the first to have received the vaccine. The vaccine, combined with screening, could wipe out cervical cancer and make it a disease of the past.

    But the percentage of women overdue for their cervical cancer screening is growing, and, alarmingly, late-stage cases are on the rise.

    We have had the heartbreaking experience of seeing mothers in the prime of life die from this avoidable disease, leaving small children behind — even women who had an abnormal screening but never received follow-up care. It’s devastating to see an otherwise healthy person slowly die from a preventable cancer.

    Simply put, cervical cancer should never occur. This Cervical Cancer Awareness Month, we should commit to making that a reality. Here is what needs to happen.

    Eliminating cervical cancer requires commitment at multiple levels, from public awareness campaigns with culturally appropriate messaging that broadcasts the power of the vaccine and screenings to prevent cancer to resources that ensure all women have easy access to routine health exams.

    Timely screening reminders and systems to prioritize follow-up care are essential. Too many women with abnormal screenings don’t receive their results, reminders or follow-up instructions they understand and, therefore don’t receive the proper treatment. Barriers also include logistical challenges like transportation and language issues. Studies suggest that 13% to 40% of cervical cancer diagnoses result from lack of follow-up among women with an abnormal screening test.

    Gynecology and primary care practices should be vigilant about reaching and monitoring patients with suspicious test findings. Large health systems can leverage the power of the electronic health record to track abnormal tests and ensure these women receive the proper follow-up.

    Pediatricians should encourage parents of children 9 and older to get the HPV vaccine and stress its safety. About 60% of teenagers are up to date on their HPV vaccines, according to the US Centers for Disease Control and Prevention. Physicians not recommending the vaccine and parents’ rising concerns about its safety, despite more than 15 years of evidence that it is safe and effective, have been cited as top reasons why more children aren’t receiving this lifesaving vaccine.

    College campuses should do large-scale, catch-up vaccination outreach. These students are at high risk for contracting HPV, yet only half report having received the full HPV vaccine series. This service should be provided at no cost to students.

    Stark racial disparities also must be addressed. As Black women physicians, we are frustrated that Black women continue to be more likely to die from the disease than any other race, according to the American Cancer Society. The system failures contributing to this tragedy range from Black women receiving less aggressive treatment to barriers around access to affordable routine health care and the high-quality, specialized treatment needed to treat cancer. Everyone deserves access to quality care.

    Older patients should be told that approval of the HPV vaccine has been extended up to age 45 and to discuss with their doctor whether it’s right for them. Insurance providers should cover the cost of the vaccine for these older ages.

    Women should see a gynecologist on a regular basis well into their older years. We see patients with cervical cancer in their 60s and 70s who haven’t been screened in 20 years. Many people stop seeing a gynecologist after childbearing or menopause, but this shouldn’t be the case. Getting quality gynecological exams throughout a woman’s life is critical to preserving it.

    We also need to empower women to be their own advocates through health education. Women should receive their screening result with an explanation of what it means and any next steps clearly delineated. No news after a screening is not good news. In an ideal world, women would see their HPV status as essential information with the power to save their lives.

    Education makes a difference. At NewYork-Presbyterian and Weill Cornell Medicine, we produced a series of easy-to-understand, publicly available videos on cervical cancer and the HPV vaccine. We showed several of the vaccine videos to more than 100 parents in one of our pediatric practices that serves mostly low-income families as part of a pilot study. Their knowledge scores on a questionnaire about the vaccine and HPV that they completed before and after watching the videos increased nearly 80%, and roughly 40% of the unvaccinated children received the HPV vaccine within one month. We aim to expand this effort.

    We have the tools to prevent cervical cancer but fail to use them effectively. It’s unacceptable, and we can no longer ignore the problem. It’s time for a full-scale offensive focused on all fronts to make cervical cancer a disease of the past.

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  • What experts say about exercising when you’re tired | CNN

    What experts say about exercising when you’re tired | CNN

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    Editor’s Note: Seek advice from a health care provider if you have chronic sleep loss and also prior to starting a workout program.



    CNN
     — 

    It’s the end of another long day at the office after a poor night’s sleep. As usual, you’re exhausted, yet you want to stop at the gym on the way home to get the exercise you need to stay healthy.

    Should you work out when you are suffering from chronic sleep loss?

    This conundrum is a widespread problem, considering 1 in 3 Americans are sleep deprived, according to the US Centers for Disease Control and Prevention.

    “It is definitely a bidirectional relationship, not one or the other,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

    “First, there is clear data to show that regular exercise improves sleep quality — moderate exercise in the morning, afternoon or very early evening can improve deep sleep,” Zee said.

    Deep sleep is the healing stage in which your body repairs and restores itself. Also called “slow wave” sleep, it can only be achieved if your sleep quality is good, with few to no nighttime interruptions.

    “Research also shows that if you sleep better, you’re more likely to be able to engage in exercise and your physical activity levels are going to be higher,” Zee said.

    “So I would say that even if you have had a bad night’s sleep, you should maintain your physical activity.”

    To be healthy, the body needs to move through four stages of sleep several times each night. During the first and second stages, the body starts to decrease its rhythms. Doing so prepares us for the third stage — a deep, slow-wave sleep where the body is literally restoring itself on a cellular level, fixing damage from the day’s wear and tear and consolidating memories into long-term storage.

    Rapid eye movement sleep, called REM, is the final stage in which we dream. Studies have shown that missing REM sleep may lead to memory deficit and poor cognitive outcomes as well as heart and other chronic diseases and an early death.

    On the flip side, years of research has found sleep, especially the deepest, most healing kind, boosts immune functioning.

    Since each sleep cycle is roughly 90 minutes long, most adults need seven to eight hours of relatively uninterrupted slumber to achieve restorative sleep and be healthy, according to the CDC. Sleep debt, along with irregular sleep duration, has been linked to an increased risk of obesity, heart disease, dementia and mood disorders such as anxiety and depression.

    One night of poor sleep shouldn’t have to impact your workout routine, but chronic sleep deprivation leading to multiple days of exhaustion is another matter, experts say.

    It may not be wise to hit the gym or play a sport when you’re barely putting one foot in front of the other, said sleep specialist Dr. Raj Dasgupta, an associate professor of clinical medicine at the University of Southern California’s Keck School of Medicine.

    “Without sleep, your muscles can’t recover from the stress you put them through during workouts. It doesn’t do you much good to keep breaking down your muscles without giving them time to recover and grow stronger,” Dasgupta said.

    In addition, you’re more likely to suffer an injury when you’re exhausted, he explained, due to slowed reaction times from your tired brain working to make decisions during the workout or sport.

    “Poor sleep can also affect your motivation to exercise in the first place. You might find yourself dreading your normal workouts and hating every minute in the gym, which is not good for long-term adherence to a fitness plan,” Dasgupta said.

    In addition, sleep deprivation can lead you to make poor food choices, which affect your fitness and physical performance, he said.

    So it’s not a good idea to work out while extremely tired, but you will also sleep better and get more out of exercise if you do. What’s the answer?

    Use common sense, Zee said. “If you’re not sleeping well, don’t go for that intense workout, right? Walk or do yoga instead, but certainly maintain an exercise or physical activity regimen at the regular time of the day that you normally would be doing it.”

    If you’re pressed for time, consider fitting in several short bouts of exercise throughout your day.

    “Everything counts,” Dasgupta said. “Do anything that makes you feel happy and refreshed. This is about hitting the reset button for yourself, not doing some form of exercise because you feel obligated to.”

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  • Alabama attorney general says people who take abortion pills could be prosecuted | CNN Politics

    Alabama attorney general says people who take abortion pills could be prosecuted | CNN Politics

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    CNN
     — 

    Alabama’s Republican attorney general said this week that women in the state who use prescription medication to terminate their pregnancies could be prosecuted under a chemical-endangerment law, even though Alabama’s anti-abortion law does not intend to punish women who receive abortions.

    Steve Marshall made the comments in the wake of a decision earlier this month by the US Food and Drug Administration to allow certified pharmacies to dispense the abortion medication mifepristone to people who have a prescription.

    “The Human Life Protection Act targets abortion providers, exempting women ‘upon whom an abortion is performed or attempted to be performed’ from liability under the law,” Marshall said in a statement to AL.com on Tuesday. “It does not provide an across-the-board exemption from all criminal laws, including the chemical-endangerment law—which the Alabama Supreme Court has affirmed and reaffirmed protects unborn children.”

    The chemical endangerment law was passed in 2006 amid high drug usage in Alabama with aims of protecting children from chemicals in the home, but district attorneys have successfully applied the law to protect fetuses of women who used drugs during pregnancy.

    It’s unclear if there are any pending cases against women in Alabama in the wake of the FDA’s announcement. CNN has reached out to Marshall’s office for comment.

    At least one Democrat, Alabama state Rep. Chris England, argued on Twitter that the chemical endangerment law is “extremely clear” and under it, a woman could not be prosecuted for taking a lawfully prescribed medication.

    “Any prosecutor that tries this, or threatens it, is intentionally ignoring the law,” England wrote on Thursday morning.

    Emma Roth, an attorney with Pregnancy Justice, a nonprofit that provides legal representation for women charged with crimes related to pregnancy, said on Twitter that the effect of Marshall’s comments will be to create “a culture of fear among pregnant women.”

    The comments are “extremely concerning and clearly unlawful,” Roth elaborated in a statement to CNN. “The Alabama legislature made clear its opposition to any such prosecution when it explicitly exempted patients from criminal liability under its abortion ban.”

    The chemical endangerment law says it does not require reporting controlled substances that are prescription medications “if the responsible person was the mother of the unborn child, and she was, or there is a good faith belief that she was, taking that medication pursuant to a lawful prescription.”

    Mifepristone can be used along with another medication, misoprostol, to end a pregnancy. Previously, these pills could be ordered, prescribed and dispensed only by a certified health care provider. During the Covid-19 pandemic, the FDA allowed the pills to be sent through the mail and said it would no longer enforce a rule requiring people to get the first of the two drugs in person at a clinic or hospital.

    Marshall’s comments underscore the legal uncertainty wrought by the Supreme Court’s decision last year to end the federal right to an abortion. In the wake of the Dobbs decision, several Republican-led states passed strict anti-abortion laws, while several others, including Alabama, that had passed so-called trigger laws anticipating an eventual overturn of Roe v. Wade, saw their new restrictions go into effect.

    While the anti-abortion movement seeks to prevent abortions from taking place, it has often opposed criminalizing the women who undergo the procedure.

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  • NICU mom stays by her son’s side after his nurses leave to strike | CNN Business

    NICU mom stays by her son’s side after his nurses leave to strike | CNN Business

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    New York
    CNN
     — 

    Lora Ribas hasn’t left her son’s bedside in four days.

    Her one-year-old baby, Logan, has been in the neonatal intensive care unit (NICU) since he was born. For the past three and a half months, he’s been under the care of Mount Sinai Hospital where thousands of nurses are currently striking.

    Logan was born prematurely at 27 weeks and is on a ventilator because his lungs were underdeveloped.

    Mount Sinai’s NICU has been consistently understaffed even before the strike, Ribas said. But since Mount Sinai’s nurses began picketing Monday, new travel nurses have replaced Logan’s primary care nurses – nurses who don’t fully understand her son’s needs, she said.

    Ribas said she’s too scared to leave her son alone under the care of the new travel nurses. She took a leave from work to stay by his side.

    “It’s scary to think that I can’t even go to the bathroom without me being concerned,” Ribas told CNN.

    Although the travel nurses are trying to compensate, they “don’t really know my son” and are still learning where supplies are around the unit, Ribas said.

    They aren’t able to give him one-on-one care because of the staffing shortages, according to the mom, and she said the staffing levels are even lower at night.

    Two nurses currently working inside Mount Sinai Hospital told CNN Monday that additional traveling nurses have not shown up as expected on their floors to replace nurses that are striking, causing stress for patients and staff.

    Mount Sinai Health System did not immediately respond to CNN’s request for comment.

    In preparation for the strike, Mount Sinai announced Friday it would transport newborns in its intensive care unit to other area hospitals. But the most critical babies – like Logan – have stayed in the hospital’s NICU unit. One NICU nurse at Mount Sinai who spoke to CNN on condition of anonymity, said moving a NICU baby to another hospital can be a risky move.

    “It’s a big journey for a baby who’s never been outside the hospital,” she told CNN. “It’s not anything that we want to happen. We want our babies to stay.”

    The more critical the baby’s condition is, the more complicated a transfer to another hospital becomes, the nurse explained.

    “You would need at least a doctor or nurse practitioner, a respiratory therapist if the patient is on respiratory support and a transport nurse to work the pumps and administer medicine if needed,” she said.

    Ribas said her son’s primary nurses who are striking right now are heartbroken they had to leave him and have been calling her to check on his status.

    “He has really wonderful primary nurses,” she said. “They were in tears having to leave him because my baby suffered cardiac arrest two days before the strike happened, and so now I’m dealing with that plus the shortage of staff. Which is very scary.”

    The nurses strike at two private New York City hospitals – Montefiore and Mount Sinai – involving over 7,000 nurses entered its second day Tuesday. Montefiore said it was holding bargaining sessions Tuesday. Mount Sinai has no plans to do so, according to the nurses’ union.

    The sticking point continues to be enforcing safe staffing levels, New York State Nurses Association (NYSNA) union officials said.

    A pediatric oncology nurse at Mount Sinai who administers chemotherapy to children with cancer said it’s hard to leave her patients to strike, but she knows it’s in the best interest of their care.

    “We love these patients more than anything,” Melissa Perleoni said, “and it breaks our heart – at least it breaks my heart – to be out here but I have to do this for the future of their care.”

    Ribas said she hopes hospital management reaches a contract with the nurses soon.

    “The nurses are the heart of the NICU, and they do need to figure it out before it becomes a different situation – because every single minute, every hour, the babies are running a very, very high risk of even dying in here.”

    “There’s nothing that could bring your kid back. Nothing,” she said.

    – CNN’s Tami Luhby, Vanessa Yurkevich and Mark Morales contributed to this report

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  • Nurses at Mount Sinai Morningside and West reach tentative agreement as more than 7,000 nurses still due to strike | CNN Business

    Nurses at Mount Sinai Morningside and West reach tentative agreement as more than 7,000 nurses still due to strike | CNN Business

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    New York
    CNN
     — 

    Mount Sinai Morningside and West hospital reached a tentative agreement with the state nursing union on a new contract Sunday, avoiding a strike Monday morning, according to a news release from the union.

    Nurses at two other area hospitals, Mount Sinai Hospital and Montefiore Bronx, are still due to strike after not reaching agreements.

    Both hospitals are back at the bargaining table with New York State Nurses Association nurses today – if a tentative agreement is not reached, then approximately 3,625 nurses at Mount Sinai and approximately 3,500 nurses at Montefiore Bronx will strike at 6 a.m. Monday. The union said during a news conference Sunday morning that negotiations could go into the early morning.

    The new tentative agreement at Morningside and West brings the anticipated number of nurses to strike down from 8,700 to about 7,125. The tentative agreement improves staffing, protects benefits and increases salaries over three years.

    That brings seven of the 12 New York hospitals in negotiations to reach tentative agreements or new contracts.

    “The time is now to settle fair contracts that help nurses deliver the care that all New Yorkers deserve. We are fighting to improve patient care and will do whatever it takes to win,” NYSNA President Nancy Hagans said in a statement Sunday.

    New York City’s Mount Sinai Hospital is continuing to move infants out of intensive care units to other area hospitals, is diverting ambulances to other facilities and postponing elective surgeries and heart surgeries ahead of a planned nursing strike Monday.

    In a statement late Saturday, the hospital said it has been negotiating “in good faith” with the nursing union on a new contract. Mount Sinai has agreed to meet with NYSNA nurses after walking out on a bargaining session Thursday, the union said Sunday.

    A Mount Sinai spokesperson told CNN on Saturday the hospital system is actively bargaining with the Mount Sinai Morningside and West campuses under separate union agreements.

    But if agreements aren’t reached at several New York City area hospitals, thousands of nurses will strike on Monday morning.

    The hospital said Sunday its current wage offer “is identical” to ratified agreements at NewYork-Presbyterian and Maimonides – and would increase a Mount Sinai nurse’s base salary by 19.1 percent over three years.

    “But NYSNA’s inconsistent bargaining, unwillingness to accept this offer, and insistence on moving forward with a strike has left us no choice but to take significant actions to care for our patients,” the hospital statement said.

    Seven neonatal intensive care unit infants were safely transferred Saturday to partner hospitals in New York City, a hospital spokesperson told CNN on Sunday. Another six will be transferred Sunday from the NICUs at Mount Sinai Hospital and Mount Sinai West, the spokesperson said.

    “In addition, we have transferred close to 100 patients from the affected hospitals – The Mount Sinai Hospital, Mount Sinai West and Mount Sinai Morningside – to unaffected hospitals within the Mount Sinai system and partner hospitals in NYC and we continue to safely discharge patients who were schedule to go home.” All elective surgeries have been postponed, the spokesperson said.

    The NYSNA hit back Saturday at comments from Mount Sinai, which said Friday it was transferring infants in its neonatal intensive care units to other area hospitals because of the strike notice, adding the hospital was dismayed by the union’s “reckless” actions.

    “As a labor and delivery nurse who helps mothers to bring babies into this world, I find it outrageous that Mount Sinai would compromise care for our NICU babies in any way. We already have NICU nurses caring for twice as many sick babies as they should,” Matt Allen, the union’s regional director, said.

    “It’s unconscionable that Mount Sinai refuses to address unsafe staffing in our NICU and other units of the hospital but is now stirring fears about our NICU babies in contract negotiations,” he added.

    In a statement Saturday, the NYSNA said nurses at BronxCare and The Brooklyn Hospital Center reached tentative agreements that will improve safe staffing levels and enforcement, increase wages by 7%, 6%, and 5% annually during their three-year contract, and retain their healthcare benefits.

    On Saturday, nurses at NewYork-Presbyterian announced they had agreed to ratify their deal, but it was a close vote – 57% nurses voted yes and 43% were against.

    “Voting on whether to ratify a contract is a key component of union democracy. Just like in any democracy, there is rarely 100 percent consensus,” Hagans said in a statement.

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  • Amid negotiation gridlock between Mount Sinai Hospital and the nursing union, newborns in intensive care are caught in the middle, one nurse says | CNN Business

    Amid negotiation gridlock between Mount Sinai Hospital and the nursing union, newborns in intensive care are caught in the middle, one nurse says | CNN Business

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    CNN
     — 

    Crucial union negotiations between Mount Sinai Hospital and the New York State Nurses Association appear to be at a standstill and both parties say the other is refusing to return to the bargaining table.

    As the impasse continues between the hospital and union, the most vulnerable patients – newborns in Mount Sinai’s neonatal intensive care unit – are caught between the opposing sides, causing worry among families, one Mount Sinai nurse, who declined to provide her name out of fear of repercussions, told CNN.

    With thousands of New York nurses poised to strike early Monday morning, one of Manhattan’s famed hospitals announced Friday it would transport newborns in its intensive care unit to other area hospitals in preparation for the strike.

    A Mount Sinai Health System spokesperson confirmed to CNN Friday that neonatal intensive care unit infants would be transferred to other area hospitals because of the strike notice.

    “We are seeking a resolution [to the strike.] The impact is great,” the spokesperson told CNN.

    A NICU nurse at Mount Sinai Hospital told CNN that families of patients in the unit have been deeply concerned about moving their sick infants from one hospital to another. Moving the babies to a different facility can be “very stressful” for a NICU patient, the nurse said, as well as the parents.

    “They’ve asked us all week what’s going to happen to their babies, and what’s going to happen next week,” the nurse said.

    “It’s a big journey for a baby who’s never been outside the hospital,” she told CNN. “It’s not anything that we want to happen. We want our babies to stay. We want to be taking care of them. And it’s kind of shocking, and actually a little infuriating, that the hospital is letting it get to this point.”

    The more critical the baby’s condition is, the more complicated and riskier a transfer to another hospital becomes, the nurse explained.

    “You would need at least a doctor or nurse practitioner, a respiratory therapist if the patient is on respiratory support and a transport nurse to work the pumps and administer medicine if needed,” she said.

    The nurses who care for the sick infants often grow close to the families and develop a trusting relationship with them, especially because some babies spend weeks or even months in the NICU, the nurse told CNN.

    “They’re comfortable leaving their babies with us when they aren’t able to be there,” she said. “We keep in contact with the families after their babies have gone home – so we really do develop a close bond to these families.”

    “We treat our babies in the hospital like they’re our own kids. We’re very protective of them,” she added.

    New York State Nurses Association President Nancy Hagans has said the goal of the negotiations is to improve patient care and staffing, get fair wages and to recruit and retain nurses.

    Negotiations between the health system and the nurse’s union have been ongoing since September, a Mount Sinai Health System spokesperson told CNN Saturday, but low staffing levels have afflicted the NICU unit for years, the nurse told CNN.

    “For over three years now, we’ve been understaffed,” she said.

    The number of patients in the unit surges and falls regularly, according to the nurse, but as patient levels rise, staffing levels stay the same. The unit can surge to 64 patients, she said.

    “You feel like you’re not actually giving your all to your patients,” she said. “You’re really pulled very thin.”

    Paying close attention to infant patients is especially important, according to the nurse, because unlike other patients – even small children – they can’t verbalize pain or discomfort.

    “You really have to be on top of their vital signs and general assessment. And when you’re not able to spend as much time as you need to with them, some things do get missed,” she said. “And it’s very unfortunate.”

    CNN has reached out to the hospital regarding the nurse’s comments on low staffing.

    More than 8,700 nurses are prepared to strike Monday morning if tentative contract agreements are not reached at several hospitals, Hagans, the union president, said at a virtual news conference Saturday morning.

    As of Saturday, negotiations across New York’s hospitals were continuing at Montefiore Bronx and the Mount Sinai Morningside and West campuses, according to the nurse’s union.

    But the president of the nurse’s union told reporters Saturday the main Mount Sinai Hospital complex left the bargaining table late Thursday and no further bargaining sessions have been scheduled since.

    A Mount Sinai Health System spokesperson told CNN that hospital management is “waiting for the union to come back to us” to resume negotiations.

    The hospital said it put forth a deal at Thursday evening’s bargaining session was the same one the union agreed to for nurses at the NewYork-Presbyterian Hospital. Tentative agreements have also been reached with union nurses at Maimonides Medical Center in Brooklyn and Richmond University Medical Center in Staten Island.

    Mount Sinai also said it has offered a 19.1% compounded pay raise over three years, which is the same offer other hospital systems in the city have made.

    The NICU nurse at Mount Sinai said that nurses in her unit don’t want to strike and are hoping that they can come to an agreement with the hospital before Sunday night.

    “It truly breaks our heart having to strike and leave our patients, but unfortunately you have to do some drastic things sometimes,” she told CNN.

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  • NYC nursing union says 8,700 nurses prepared to strike Monday if tentative contract agreements not reached at remaining hospital | CNN Business

    NYC nursing union says 8,700 nurses prepared to strike Monday if tentative contract agreements not reached at remaining hospital | CNN Business

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    New York
    CNN
     — 

    More than 8,700 nurses are prepared to go on strike Monday at 6 am ET if tentative contract agreements are not reached at several New York City hospitals, New York State Nurses Association (NYSNA) President Nancy Hagans said at a virtual press conference Saturday morning.

    That’s a drop from the original estimate of 9,500, after tentative agreements were reached late Friday and Saturday morning with other facilities.

    In a statement Saturday, the NYSNA said nurses at BronxCare and The Brooklyn Hospital Center reached tentative agreements that will improve safe staffing levels and enforcement, increase wages by 7%, 6%, and 5% annually during their three-year contract, and retain their healthcare benefits.

    Negotiations are continuing at Montefiore Bronx and the Mount Sinai Morningside and West campuses ahead of Monday’s planned strike, Hagans said. The union president told reporters Saturday that the main Mount Sinai Hospital complex left the bargaining table late Thursday and has not reached out to the union to schedule any further bargaining sessions since.

    A Mount Sinai spokesperson told CNN the hospital system is actively bargaining with the Mount Sinai Morningside and West campuses under separate union agreements. The spokesperson added that management is “waiting for the union to come back to us” and resume negotiations for nurses at the main Mount Sinai hospital facility.

    On Saturday, nurses at NewYork-Presbyterian announced that they agreed to ratify their agreement, but it was a close vote – 57% nurses voted yes and 43% were against.

    “Voting on whether to ratify a contract is a key component of union democracy. Just like in any democracy, there is rarely 100 percent consensus,” Hagans said in a statement.

    To date, nurses at five New York City hospitals who were slated to strike on Monday have now reached tentative agreements or contracts.

    The NYSNA also hit back Saturday at comments from Mount Sinai, which said Friday it was transferring infants in its Neonatal Intensive Care units to other area hospitals because of over the strike notice, saying that the hospital was “dismayed by NYSNA’s reckless actions.”

    Matt Allen, the union’s regional director, said, “As a labor and delivery nurse who helps mothers to bring babies into this world, I find it outrageous that Mount Sinai would compromise care for our NICU babies in any way. We already have NICU nurses caring for twice as many sick babies as they should.”

    He added, “It’s unconscionable that Mount Sinai refuses to address unsafe staffing in our NICU and other units of the hospital but is now stirring fears about our NICU babies in contract negotiations.”

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  • US military expands leave for new parents in uniform | CNN Politics

    US military expands leave for new parents in uniform | CNN Politics

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    CNN
     — 

    The US military introduced new rights on Wednesday for military parents, doubling the amount of leave time for service members who give birth and providing leave for new parents who don’t give birth, including those who adopt and foster long-term.

    The new policy gives 12 weeks of parental leave to service members who give birth, and 12 weeks of leave for the non-birth parent. Previously, only the birthing parent was authorized six weeks of leave.

    The policy also provides 12 weeks of leave for those who adopt or have a long-term foster care placement. The 12 weeks of leave must be used in the first year of the child’s life, the Defense Department said in a news release. The new policy is effective as of Wednesday, and will retroactively apply to service members who were on maternity convalescent leave or caregiver leave as of December 27.

    “It is important for the development of military families that members be able to care for their newborn, adopted, or placed child or children … Unit commanders must balance the needs of the unit with the needs of the member to maximize opportunity to use parental leave,” Gilbert Cisneros, the undersecretary of defense for personnel and readiness, said in the memo.

    For the parent who gives birth, the new policy says that the 12 weeks of leave will follow a period of convalescence, which can be authorized by a health care provider and will begin on the first full day after the child’s birth.

    Under the policy, the 12 weeks of leave can be taken all together or in increments and says that troops may take normal leave “in between increments of parental leave or consecutively with parental leave.” It also says that parents who are deployed during the one-year leave period can be authorized an extension if they are unable to take their 12 weeks during that first year, and that any parents who place their child for adoption or have their parental rights “terminated by consent or court order” are not eligible for the parental leave.

    Family planning is often one of the most cited frustrations for service members regarding military life. The Government Accountability Office said in a report in 2020 that family planning was one of six main reasons that women cited when asked why they decided to leave the service.

    Female officers in the Air Force specifically told the GAO that they “felt they needed to ensure that pregnancy occurred at certain times in their careers to minimize negative career impacts,” and that there were often missed opportunities because of pregnancies including a loss of flying time or opportunities with professional military education.

    In an attempt to address concerns from parents in uniform, the Army released a series of changes in April last year, which gave guidance on stabilizing soldiers’ permanent change of station or deployments as they undergo fertility treatments and provided convalescent leave to service members whose spouse experiences a miscarriage or stillbirth “for emotional recovery.”

    “As an Army, we recruit soldiers but retain families,” Army Chief of Staff Gen. James McConville said at the time. “Nearly 4,500 active component enlisted men have separated due to parenthood over the last decade. … Across the entire military, 45% of all active duty married women are in dual-military marriages. This directive reaffirms our commitment to support our military families and children from pregnancy to parenthood.”

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