TIME Obesity

The FDA Has Approved an Implantable Device for Obesity

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The Food and Drug Administration (FDA) approved a new device that uses electricity to control hunger pangs

It’s the first new device for fighting obesity in nearly a decade and on Wednesday, it was FDA approved for Americans.

Called VBLOC, the device requires implanting a small pulse generator into the abdomen, making it less invasive than bariatric surgery. VBLOC took its manufacturer, EnteroMedics, 12 years to develop. It works in the gut like a pacemaker does in the heart, sending out pulses of electricity to the vagus nerve, which normally signals the brain when the stomach is empty or full. VBLOC stimulates this nerve, sending the message that the stomach is satisfied, which shuts down the urge to eat more.

For now, doctors set the device to trigger different levels of electrical stimulation, depending on how much support the patient needs. Eventually, EnteroMedics’ consulting chief medical officer, Dr. Scott Shikora, patients may be able to adjust the frequency and timing of the pulses themselves.

VBLOC is approved for those who are obese, with a body mass index of 35 to 45, and who have at least one other obesity-related medical conditions, such as diabetes or heart disease. Patients also have to have tried and failed at losing weight with a weight loss program.

“If you bring along a new technology that is much simpler, much lower risk and doesn’t dramatically change lifestyle like required of bariatric patients, then I suspect a pretty good number of patients out there will say ‘Sign me up, this is for me,’” says Shikora, who has been performing the more invasive operations for two decades in Boston. For now, it’s likely to be offered by reputable weight loss centers that also perform other obesity procedures in the coming year before expanding to other outlets.

The FDA based its decision on a trial conducted by EnteroMedics involving 157 patients who used the device and 76 patients who did not. The VBLOC group lost 8.5% more excess weight than the control group after a year. While the weight loss did not meet the study’s original goal of having the patients lose at least 10% of their excess weight, the agency decided that the benefits of the device in helping obese patients lose weight outweighed any potential risks, which included surgical complications, vomiting, heartburn, chest pain and problems swallowing. “Medical devices can help physicians and patients to develop comprehensive obesity treatment plans,” Dr. William Maisel, chief scientist in the FDA’s Center for Devices and Radiological Health said in a statement.

The agency is asking EnteroMedics to continue studying VBLOC for five years in at least 100 patients who use the device after it reaches market. Those studies will let doctors and regulators know if stimulating the vagus nerve continuously in these patients has any adverse effects on the nerve’s other functions in communicating information from the digestive tract up to the brain.

TIME ebola

Ebola Epidemic May End by June 2015 In Liberia

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SCOTT CAMAZINE—Getty Images/Photo Researchers RM At one time in 2014, Liberia experienced the fastest growing number of Ebola cases

That’s only if current hospitalization rates continue, say researchers

Understanding the ebb and flow of the Ebola outbreak that erupted in West Africa last year—and continues to percolate in the three hardest hit countries—is critical to stopping it. That means knowing who’s getting infected, where the highest rates of transmission are occurring and which strategies work best to control its spread.

Scientists initially thought that even if almost every infected person could be hospitalized, it wouldn’t stop the rapid spread of the Ebola virus for months to come. But researchers in the U.S. are now predicting in the journal PLOS Biology that the epidemic in Liberia, which at one point had the biggest explosion in Ebola cases, could peter out by June 2015.

MORE: TIME Person of the Year: The Ebola Fighters

In coming up with their predictive models, the researchers, led by John Drake University of Georgia, took into account data from previous outbreaks of Ebola, as well as probabilities about infection rates among healthcare workers, family members of the infected and those who are exposed to the virus during burials.

In order for Liberia’s Ebola outbreak to end, new hospital beds would have to be added at the same current rate (300 were provided between July and September 2014), the study authors concluded. That would allow 85% of infected patients to be treated with the nutritional and hydration therapy that is critical to overcome the infection. If new beds aren’t continually added, then hospitalization rates could drop back down to 70%, and cases may start to outpace public health workers’ ability to contain the disease.

MORE: U.N. Official Says Ebola Can Be Beat in 2015

Burial practices need to change as well. Cultural norms include touching the bodies of the deceased, which spreads the Ebola virus in a community. Safer burial practices, in which infected patients are isolated from healthy people, are keeping transmission levels under control, the authors say.

MORE: Ebola Vaccine Is Safe and Effective, According to First Study

The key to reducing the number of Liberia’s Ebola cases by summer is ensuring that anyone who is sick is hospitalized. “These modeling exercises suggested that in the absence of rapid hospitalization of most cases, none of the proposed scenarios for increasing hospital capacity would have been likely to achieve containment,” the authors write. “Continuing on the path to elimination will require sustained watchfulness and individual willingness to be treated.”

TIME Heart Disease

Popping Aspirin for Heart Health Could Be a Waste of Time for Some

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Tetra Images—Getty Images/Tetra images RF

The drug is overused in about 12% of heart patients, study finds

Study after study documents the wonders of aspirin for the heart—it can lower levels of inflammation, the trigger that sets off the unstable events of a heart attack, and it also helps blood remain free of viscous traps that can block vessels and slow the flow of blood to the heart. But these studies only support the benefits of aspirin in low daily doses for those who have already had heart events. For people who haven’t yet run into trouble but may be a higher risk of heart issues—including people who are overweight and those with high blood pressure or diabetes—the evidence isn’t so clear.

MORE: Who Should and Who Shouldn’t Take Daily Aspirin

That hasn’t stopped doctors from recommending aspirin to these patients. In a study published in the Journal of the American College of Cardiology, researchers looked at more than 68,000 people in 119 medical practices in the U.S who hadn’t had any previous heart events, but who were receiving aspirin therapy. 11.6% of them were given the drug inappropriately, the authors concluded; even though they did not meet the criteria that various groups of medical experts established as the threshold for starting the medication, they were still taking it.

Though aspirin is available over the counter, the drug comes with potential side effects that can pose serious health risks, including bleeding in the gastrointestinal tract and brain. “With aspirin being so widely used and being available over-the-counter, the concern I have is that a lot of the use may be leading to side effects that could be preventable by having a discussion between the provider and patient,” says Dr. Salim Virani, from the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine.

MORE: Daily Aspirin May Not Prevent Heart Attacks

Virani says that aspirin use among patients with no history of heart disease varies widely across the country. Among two similar patients randomly assigned to two different doctors, one would have a 63% higher chance of being given an aspirin to prevent a first heart event than the other patient.

Currently, the American Heart Association recommends that aspirin be used in such primary prevention cases only if the person has a greater than 10% chance of having a heart attack or stroke in the next 10 years. This calculation is based on the person’s age, sex, cholesterol levels, blood sugar levels, blood pressure and whether he or she smokes. Based on a review of the available literature, in 2009 the U.S. Preventive Services Task Force criteria advised starting aspirin for anyone with a great than 6% chance of having a heart attack or stroke in the next 10 years.

Despite these guidelines, most doctors are likely not making the calculations necessary to come up with this score, suspects Virani—regardless of whether they are primary care physicians or heart experts. “We know from prior data that we as providers are not good at calculating the risk of every patient because it takes time,” he says. “You have to get the equations and put all the patient’s numbers in, and in a very busy practice that could be a time drain. So most of the variation we see could be doctors just determining risk by looking at the patient rather than going to the actual data to tell them what the person’s 10 year risk [of heart disease] is.” In fact, 73% of the people in the study, which only looked at heart doctors’ practices, did not have enough information for their physicians to calculate their 10 year risk score. Of those without score data, 97% were missing critical cholesterol level readings.

The overuse of aspirin is concerning, Virani says, because it persists even after he and his colleagues adjusted for potential confounding factors, including the proliferation of statins, the cholesterol-lowering drugs that can also reduce inflammation. Because more people are on statins, including those who have not yet had a heart event, it’s possible that the drugs are lowering the 10-year risk of a heart attack or stroke by more than the other factors that doctors usually use to calculate risk and the need for aspirin. In other words, there may be more people who no longer need aspirin because they are taking statins.

Virani admits that his study still leaves a lot of questions unanswered, like dosage and whether a doctor recommended the drug or the person started taking it on their own.

Part of the reason for the inappropriate use could be an artifact of the aggressive prevention and awareness campaigns surrounding heart disease. Though they’ve been extremely effective at informing people about the many ways to avoid heart trouble, like changing your diet, exercising regularly and taking drugs like statins or aspirin, the message isn’t one-size-fits-all. That’s important for aspirin in particular, since the medication can come with harmful side effects that overshadow any potential benefit they might have. It’s enough of a concern that the Food and Drug Administration recently rejected a request to add primary prevention of heart disease as a benefit of aspirin therapy on the drug’s label.

These latest results only reinforce that decision. It’s clear that when it comes to whether aspirin can prevent a first heart attack, neither doctors nor patients are being guided by the evidence—and that could mean more health complications for more people.

TIME Mental Health/Psychology

Here’s Proof That Facebook Knows You Better Than Your Friends

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Peter Dazeley—Getty Images Facebook Likes reveal a lot about your personality

Your operating system knows you so well, says science

Nobody knows us better than our family and friends, right? Who else could predict how we’ll react to good and bad news, or whether to pick the pie or ice cream for dessert?

Facebook, for one. Researchers at the University of Cambridge and Stanford University studied how Facebook Likes matched up with people’s own answers on personality tests, as well as those of their close family and friends. With enough Likes of objects, brands, people, music or books, the computer was better at predicting a person’s personality than most of the people closest to them—with the exception of spouses. (They still know us best, it seems.)

MORE: Why a Facebook ‘Sympathize’ Button Is a Terrible Idea

Wu Youyou, a PhD student in the Psychometrics Center at the University of Cambridge, and her colleagues had previously investigated how computer models could predict demographic and psychological traits in people. But inspired by the movie Her, they were curious about how the models would do in evaluating personality traits. They asked 86,220 people on Facebook to complete a 100-question personality survey that determined where they stood on the so-called Big Five traits: openness, conscientiousness, extraversion, agreeableness and neuroticism. They then analyzed their Facebook Likes to generate a model in which Likes were linked to the traits. Likers of meditation, TED talks and Salvador Dali, for example, tended to score higher on openness, while those who liked reality star Snookie, dancing and partying were more extraverted.

On average, people on Facebook had 227 Likes, and this was enough information for the computer to be a better predictor of personality than an average human judge (in other words, a friend), and almost as good as a spouse. The more Likes, the better the computer got. It only took 10 Likes for the computer to outperform a work colleague, for instance, 70 to do better than a friend, and 150 to outscore a family member.

MORE: How Well Do You Know Your Facebook Friends?

“We know people are pretty good at predicting people’s personality traits, because it’s such an important thing in all of our interactions,” says Youyou. “But we were surprised by how computers were able to do better than most friends by using just a single kind of digital data such as Facebook Likes.”

Computers are such good predictors because they can take all the Likes at face value and treat them equally, says Youyou’s co-author Michal Kosinski from Stanford’s department of computer science. People tend to forget information if it’s not top of mind and tend to give more weight to memorable or recent events, potentially biasing our evaluations. But computers can treat each piece of information objectively.

MORE: Your Facebook Profile is Also a Professional Tool

Still, the computer strategy isn’t always entirely accurate. It can’t account for changes in people’s moods and behaviors and outlooks, and given that people are notoriously dynamic, that could be a problem. (People who scored higher on the extraversion scale, for example, did like meeting new people but also inexplicably Liked Tiffany & Co., while those who were more conscientious expressed preferences for mountain biking and motorcycles.) But Kosinski thinks that this kind of computer modeling could help processes like career planning and job recruitment. People just entering the job market could benefit from such personality profiling, which could better link them to the right industries and jobs in those sectors. A free spirit who likes to travel, explore and take risks, for example, likely wouldn’t be happy as an accountant, while an introverted person wouldn’t be ideal for a marketing or public relations position.

Kosinski also speculates that computers could streamline job recruitment. Many companies use personality questionnaires, especially when seeking high-level executives, but such questionnaires can be inaccurate and unreliable, as candidates are incentivized to give the answers they think the company wants to see. Computers might be able to come up with a more accurate personality profile than these questionnaires, if the Facebook data are any indication.

Kosinski recognizes that applying such models is tricky. “We have to be really cautious and make sure we don’t upset people and don’t do anything that breaches the trust between the applicant and the employer, if the employer starts testing without explicit consent,” he says. “But we certainly hope that these technologies can be used to better human life.”

Read next: How Much Time Have You Wasted on Facebook?

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TIME HIV/AIDS

This Contraceptive Is Linked to a Higher Risk of HIV

Depending on the contraceptive they’re using, women may be at higher risk of getting HIV

When it comes to the double duty of preventing both pregnancy and HIV, condoms are the best option, especially in the developing world where treatment for the infectious disease is harder to access. But the same isn’t true of other contraceptive methods, according to the latest study in Lancet Infectious Diseases.

Lauren Ralph, an epidemiologist at University of California San Francisco, and her colleagues conducted a review of all of the available studies on hormonal contraceptive methods—including injections of Depo Provera and Net-En that work to prevent pregnancy for about 12 weeks, as well as the pill. Among 12 studies involving nearly 40,000 women in sub-Saharan Africa, those using Depo showed a 40% higher risk of getting HIV than those using other methods or no contraception at all.

Previous studies suggested that Depo, which is made up of a hormone that mimics the reproductive hormone progesterone, was linked to higher risk of infection, but other studies showed conflicting results. Ralph found that only Depo was associated with a higher risk of HIV infection; there was no similar increase among women using the pill, which is composed of two hormones, estrogen and a form of progesterone. The correlation remained even after they considered potentially confounding factors, such as the women’s condom use.

While the study didn’t address the reason for the difference between oral contraception and Depo, some research suggests that their differing hormone combinations may have varying effects on the structure of the genital tract, a woman’s immune response or her vaginal flora, all of which could influence her vulnerability to acquiring HIV.

The results raise a difficult question about whether the increased risk of HIV infection warrants removing Depo from a woman’s contraceptive options in places like Africa. Worldwide, according to the authors, 41 million women use injectable contraception, and they have played a role in lowering death and health complications among women of child-bearing age. “Whether the risk of HIV observed in our study merits complete withdrawal of hormonal contraception, especially Depo, needs to be balanced against the known benefits of highly effective contraception in reducing maternal morbidity and mortality worldwide,” says Ralph, who conducted the research while at University of California Berkeley. More research needs to be done to quantify the risks and benefits of providing Depo, and these calculations also have to be adjusted for specific regions and even particular clinics. “One thing to consider is whether women have access to other contraceptive options, whether they will be willing to take up these contraceptive options, and ensuring that women will be comfortable with them,” she says. “I would love to see these findings applied to specific regions. I think that would help women make the most informed decisions.”

TIME medicine

Genetic Testing Company 23andMe Finds New Revenue With Big Pharma

The company’s database of genetic information is worth $10 million to Genentech

The past two years have been a rough and transformative time for the controversial DIY genetic testing company 23andMe. At the end of 2013, the Food and Drug Administration requested that the company shut down its main service, an analysis of a person’s genome gleaned from spit samples that anyone who purchased a kit could send in, noting that interpreting human genes—understanding what changes in DNA mean, and how they contribute or don’t contribute to disease—is still too much of a black box.

But things may be looking better for the company in 2015. On Jan. 6, it announced a $10 million partnership with biotech company Genentech, which will sequence the entire genomes of 3,000 23andMe customers with a higher risk for developing Parkinson’s disease. Genentech is hoping the information will speed development of more effective drugs against the neurodegenerative disorder, in which motor nerves in the brain start to deteriorate. “What attracted us to 23andMe and this opportunity is the work 23andMe has done together with the Michael J. Fox Foundation in the Parkinson’s space,” says Alex Schuth, head of technology innovation and diagnostics for business development at Genentech. “They have built a community of individuals and their family members who have contributed DNA samples. What is unique about this cohort is that it gives us an opportunity to connect clinical data on how patients feel and how their disease is progressing, with their genomic data. That’s unique.” The 23andMe customers will be asked to sign new consent forms as part of any Genentech studies.

MORE Time Out: Behind the FDA’s Decision to Halt Direct to Consumer Genetic Testing

The agreement is one of many that 23andMe CEO and co-founder Anne Wojcicki says are in the works, and hint at the company’s most valuable asset—the genetic information on the 800,000 customers who have sent in their DNA-laden saliva since the company began selling kits in 2006. “Databases, and big data, is suddenly trendy,” says Wojcicki, “especially in health care where people are recognizing that when you have really large numbers, you can learn a lot more. I think we are leading part of that revolution.”

But for the past year, the company hasn’t been sending back health information to customers who pay the $99 for an analysis. Instead, customers are getting reports on their genetic ancestry, with the promise that when the FDA permits it again, they will receive health-related information based on their genetic profile. Wojcicki says that since the FDA action, sales of the kits have been cut by about half, and while they are slowly climbing back up, they haven’t yet reached pre-2013 levels.

Regaining that market is a top priority for 23andMe, says Wojcicki. “Everyone at the company has some kind of role, some involvement, in thinking about the FDA,” she says. “It has transformed the entire company—our product, our execution, how to think about marketing, every aspect of it.” The two entities are exchanging requests and responses, and while she hopes to have a resolution in 2015, it’s not clear yet when the health-related services will be offered.

In the meantime, the genetic information 23andMe has already collected is becoming a potential gold mine for academic researchers and for-profit drug developers. The company has more than 30 agreements with academic researchers for which they receive no monetary compensation, so that scientists can learn more about certain diseases and contribute to basic knowledge about what goes wrong in those conditions. Wojcicki says she’s balancing opportunities with both non-profit and for-profit companies to optimize the value of 23andMe’s database. “Some research has absolutely no monetary capacity, and we should still do those, because fundamentally what 23andMe does is represent the consumer,” she says. “And some research does have monetary capacity, and we should do those too. Because the reality is that the group that is going to develop a drug or treatment or therapy for something like Parkinson’s disease is going to be a for-profit company.”

Read next: These GIFs Show the Freakishly High Definition Future of Body Scanning

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TIME flu

Here’s Where to Find Out If You’re Likely to Get the Flu

It’s not enough to know if your state is a flu hot zone. Now you can find out if the street you live on is teeming with flu cases

With this year’s flu season nearing epidemic levels — it’s widespread in 43 states, according to the Centers for Disease Control and Prevention (CDC) — prevention (and preparation) is certainly your best medicine.

Fortunately, there is no shortage of apps and websites that can help. Flu tracking is a popular subject, and ever since Google Flu Trends launched in 2008, it seems everyone wants to know how prevalent flu is — not just in their state and in their city, but in their neighborhood and even their office building. (Facebook can even help you figure out which of your friends might have given you the flu but tracking members’ posts about the illness and its symptoms.)

And while none are perfect, there are a few good ones.

The CDC’s FluView:

It gathers data from clinics, urgent care centers, doctor’s offices and hospitals and reports the number of people coming in with flu-like symptoms — fever, cough, sore throats, muscle aches — and people who test positive for the bug. It offers a good snapshot but it has some shortcomings. Because it logs symptoms in addition to diagnosed cases, there’s a chance that some of the fever and respiratory problems could be something else entirely. It also doesn’t record the countless people who likely just decide to weather out their illness at home with over-the-counter remedies or some chicken soup. There’s also a lag in the reporting, which means FluView can’t provide a real-time look at what the virus is doing at a given time.

The CDC has an epidemiologist studying alternative ways of collecting flu information, including crowdsourcing, to see if the CDC can provide more real time data. “There is potential there,” says Lynnette Brammer, an epidemiologist in the influenza division at CDC. “But with any data set you’ve got to know how to appropriately interpret that data and when you might be over reaching.”

MORE: Why Some Experts Want Mandatory Flu Shots For School Kids

Flu Near You:

This app is more granular, portraying in real time the actual level of flu activity in a given area. It can pinpoint your location down to the street and give you a low-moderate-high reading on flu activity. It’s based on self reports from people who register on the app and voluntarily provide information on their sniffle status on a weekly basis. Blue dots indicate people who are still symptom-free, while yellow dots indicate people who might have some of the symptoms of flu — including fever, coughs, or sore throats — and red dots represent people who meet the CDC criteria for influenza-like illness: fever over 100F and a cough or sore throat that’s not caused by any other known infection.

Self-reporting may not provide an entirely accurate picture either, however. To address such confounding factors, Flu Near Your deletes the first two reports by newcomers, to reduce the possibility that new users are just playing around with the app, but there’s still no way to verify the symptoms that people log in. But so far, Mark Smolinski, director of global health for Skoll Foundation Global Health Threats, which created the app, is confident that the reports are valid, since they track pretty well with the CDC data.

Alexis de Belloy, who pores over the Flu Near You data, says that registration for the app is up 40% compared to last year, and the proportion of them who actively respond to the weekly surveys is also up; the more participants, the stronger and more reliable the signal generated by the users.

The Flu Forecaster:

Jeffrey Shaman, professor of at the Mailman School of Public Health at Columbia University, decided to combine a bit of both the CDC and real-time strategies into his flu forecaster, which he launched last year. You can select your city and receive a chart of when flu is likely to peak where you live. It’s based on the same predictive modeling that weather forecasters use — combining information from past flu seasons and current trends to make educated guesses about the ebb and flow of cases in the future. “There are problems with all data, so I don’t think any data should be used in isolation,” he says. “We should consider them all until we have that gold standard.”

And it’s not just an academic exercise. Smolinski points out that critical public health information can be gleaned from flu tracking and forecasting, such as how effective a particular flu season’s vaccine is. By comparing rates of illness among people who have been vaccinated and those who haven’t, doctors can get a good sense of whether the shot is a good match for circulating flu strains or not. It can also help doctors, hospitals and pharmacies to make informed decisions about stocking flu remedies like Tamiflu so everyone who needs them will have access to them.

In Australia, crowd-based online surveillance is becoming the country’s go-to resource on flu tracking. Their system, FluTracking.net, asks participants about whether they have had a fever or cough every week during the flu season; since the program began in 2006, more than 16,000 people now complete the survey regularly. In Europe, 10 countries participate in Influenzanet, an online flu tracking system that also relies on volunteers to report on their symptoms weekly.

“It’s what’s coming down the pike, and what’s going to be in our future,” says Shaman of the real time information from the public. “We already get pollution levels and the pollen count. Why not have a real time flu forecast?”

TIME medicine

Why Working at Night Boosts the Risk of Early Death

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Image Source—Getty Images Nurses working more night shifts were at higher risk of dying early

Working while the rest of the world is sleeping may increase your risk of cancer and heart disease

Sleep isn’t just a time to rest and give your body and brain a break. It’s a critical biological function that restores and replenishes important body systems. Now, yet another study on shift workers shows that their unusual hours may be cutting their lives short—and that’s especially true for those who have rotating night shifts, rather than permanent graveyard duty.

In a study published in the American Journal of Preventive Medicine, scientists led by Dr. Eva Schernhammer, an epidemiologist at Brigham and Women’s Hospital, studied 74,862 nurses enrolled in the Nurses’ Health Study since 1976. The nurses were an ideal group for studying the effects of rotating night shifts on the body, since RNs tend to have changing night shift obligations over an average month rather than set schedules.

MORE: The Power of Sleep

After 22 years, researchers found that the women who worked on rotating night shifts for more than five years were up to 11% more likely to have died early compared to those who never worked these shifts. In fact, those working for more than 15 years on rotating night shifts had a 38% higher risk of dying from heart disease than nurses who only worked during the day. Surprisingly, rotating night shifts were also linked to a 25% higher risk of dying from lung cancer and 33% greater risk of colon cancer death. The increased risk of lung cancer could be attributed to a higher rate of smoking among night shift workers, says Schernhammer.

The population of nurses with the longest rotating night shifts also shared risk factors that endangered their health: they were heavier on average than their day-working counterparts, more likely to smoke and have high blood pressure, and more likely to have diabetes and elevated cholesterol. But the connection between more rotating night shift hours and higher death rates remained strong after the scientists adjusted for them.

MORE: Why You Shouldn’t Read a Tablet Before Bed

The data support the idea that changing the body’s natural rhythms by being active at night and asleep during the day may have harmful consequences, especially if you shift this rhythm inconsistently. “It’s sort of like flying between London and New York every three days — constant jet lag,” says Schernhammer. “However, if you fly from London to New York and stay in New York, then jet lag would subside after a few days, and that’s what we assume happens in permanent night workers.”

Why does the body react when sleep cycles change? Previous studies showed that too little sleep or the kind that’s disrupted can alter melatonin levels so that the body never powers down and slips into restorative mode, a time when much-needed repairs are made to cells and tissues and supplies of nutrients are replenished to the body. Without this period of rest, important processes such as inflammation, fat and sugar metabolism and immune functions get out of balance, creating fertile ground for heart disease or cancer. The growing number of studies connecting shift work with unhealthy outcomes led the World Health Organization to classify shift work as a probable carcinogen in 2007.

MORE: These 6 Things Will Bring You a Great Night’s Sleep

Schernhammer and her colleagues show that the categorization may have merit, but not everyone can avoid night shift work. Researchers are studying how these people might counteract some of the effects of their unusual work hours, but none of these strategies, including light lamps and sleep aids, has so far been proven to help. In the meantime, she says that shift workers concerned about their risk should do everything they can to lower their risk of heart and cancer risk in other ways — by quitting smoking, getting enough exercise, eating a healthy diet and getting regular cancer screenings. “Hopefully in the near future we can also recommend additional measures that alleviate some of the strain that night work imposes on the circadian system,” she says, “by matching their shift schedules, to the extent possible, with their inherent sleep preferences — whether they are night owls or morning types.”

TIME Cancer

Your Chances of Surviving Cancer May Depend on Where You Live

Cancer deaths across the country have been dropping, but some states are doing better than others

In its annual report on cancer rates and deaths, the American Cancer Society (ACS) reports that deaths from cancer have dropped by 22% over the past 20 years, saving 1.5 million lives.

The review, published in the journal CA: A Cancer Journal for Clinicians, included data from 2007 to 2011 and found that decreases in deaths from four major cancers—lung, breast, prostate and colon—are driving much of the improvement. More widespread screening, which is leading to early detection and treatment, is helping to find more cancers and manage them before they become fatal, says Rebecca Siegel, director of surveillance information for the ACS and lead author of the study. Deaths from prostate and colon cancers have dropped by almost half since their peak several years ago, and lung and breast cancer have declined by about a third from their highest rates.

But the data also show a disturbing trend of slower progress in southern states. On average, death rates in the lower part of the U.S. have declined by about 15%, compared to drops of 25% to 30% in Delaware, Maryland, Massachusetts and New York.

The reason for the smaller declines, says Siegel, may have a lot to do with higher smoking rates in states like South Carolina and Kentucky, as well as more obesity and greater disparities in socioeconomic status. People with lower incomes are less likely to have access to cancer screening and treatment programs. “We are seeing large differences by state,” she says. “We need to reach everyone in the population with advances in early detection and improvements in treatment because they just aren’t equally disseminated. That’s why you see differences; it’s not just biology.”

The improvements in northeastern states shows that it’s possible. “If we could apply everything we know to everyone in the U.S., there would be enormous gains from just that,” says Siegel.

That’s especially important as the population continues to age. Since cancer is generally a disease of aging, the absolute number of cancer diagnoses, and potentially deaths, could increase. (In 2015, an estimated 589,430 Americans will die of cancer.) But expanding screening programs and ensuring that more people have access to them could help keep cancer rates and deaths trending downward.

Read next: Most Cancer Is Beyond Your Control, Breakthrough Study Finds

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