TIME ebola

U.S. Ebola Patient ‘Fighting for His Life’

Residents Quarantined In Dallas Apartment Where Ebola Patient Had Stayed
Dallas County, County Judge Clay Jenkins walks with an acquaintance from the apartment where an Ebola virus patient was staying at the Ivy Apartments on October 3, 2014 in Dallas, Texas. Joe Raedle—Getty Images

The four people in the apartment with an Ebola patient before he became ill have been moved to a secure location, Dallas health officials say.

Updated Sunday, Oct. 5

The first person to develop the Ebola virus in the United States is in critical condition, a spokesperson for the Dallas hospital where he’s being treated said Saturday. The patient, Thomas Duncan, was previously listed in serious condition, and his change in status means his health is degrading.

“We understand that his situation has taken a turn for the worse,” Centers for Disease Control and Prevention Director Dr. Thomas Frieden said of Duncan’s condition in a Sunday press conference. Frieden added that Duncan is “fighting for his life.”

The news of Duncan’s failing health comes as his partner and the three young men living with her in the Dallas apartment where Duncan stayed before he became sick were moved to a temporary residence. Dallas County Judge Clay Jenkins, who heads up the city’s emergency response, drove the four individuals to their new home on Friday night. Jenkins said on Friday that he hoped to find them accommodations with appliances that would make the four family members more comfortable during their quarantine, such as their own washer and dryer.

In a Saturday news conference, Frieden said CDC and local health officials are now monitoring 40 people who had some level of contact with Duncan, including nine who had direct contact with Duncan. It’s not clear how many of those are health care workers or patients at Texas Health Presbyterian Hospital, where Duncan is being treated, and how many are community members, including those who live in the apartment complex. On Sunday, a homeless man with whom Duncan had some level of contact was found after being sought by officials for monitoring.

Medical waste generated by Duncan during his stay at the hospital, including gowns and personal protective equipment worn by health care providers caring for him, remain at the hospital, said Dr. David Lakey, commissioner of the Texas Department of State Health Services. The waste removal company has now secured the proper Department of Transportation hazmat permits to transport the waste, and is set to do so on Monday.

Duncan originally went to the hospital on Sept. 25, but was released despite having told staff there he recently traveled to Liberia, the heart of West Africa’s Ebola crisis. He was re-admitted three days later when his condition worsened. While Texas Health Presbyterian Hospital originally blamed technical glitches for the failure in getting Duncan’s travel history to the right people, the facility walked back that claim Saturday, raising questions about the hospital’s procedures during what’s become the worst-ever Ebola outbreak.

TIME Sex/Relationships

How Previous Sexual Partners Affect Offspring

At least, if you’re a fly. But the research suggests that it may be time to take into account more than just DNA when it comes to our offspring

It’s a long-held belief among animal breeders that pure-bred progeny are best produced by females who have never mated before. Call it puritanical or ridiculous, but in breeding, it’s been a long-standing practice—even though there has never been much science to back it up. Now, however, researchers at University of New South Wales in Australia believe they may finally have some evidence to give that notion some scientific support.

Working with flies, Angela Crean, a research fellow at the evolution and ecology research center, picked up on her mentor’s work of looking at how male factors can influence offspring outside of the DNA in his semen.

“The genetic tests showed that even though the second male fertilized the eggs, the offsprings’ size was determine by the condition of the first male,” she says of her findings, published in the journal Ecology Letters. “The cool thing is that the non-genetic effects we are seeing are not necessarily tied to the fertilization itself.”

Cool, or really disturbing. The implications of the study are that any mates a female has had may leave some legacy—in the form of physical or other traits that are carried in the semen (but not the DNA-containing sperm)—that could show up in her future offspring with another mate.

While there’s a growing body of work showing that a mother’s diet, her smoking status, and other lifestyle habits can have an influence on her offspring, the data on similar factors on the father’s side is just emerging. With flies it’s known, for example, that males who eat a maggot-rich diet while they’re mere larvae, develop into larger than average adults, and on top of that, sire larger than average offspring as well. Males fed a meager maggot diet tend to be smaller have have smaller progeny.

Eager to learn how this was happening, Crean conducted a series of mating experiments with female flies when their eggs were immature. At that stage, the eggs are more receptive to absorbing factors in semen, but because they aren’t fully developed, they can’t be fertilized and won’t result in baby flies. When she and her colleagues “mated” these females with males who were larger, then allowed the females to actually mate with smaller males once they were mature, the offspring turned out to be large, just like the first males the females had sexual contact with. Genetically, they were the offspring of the second, smaller male, but physically, they resembled the larger males.

The same was true when they reversed the experiment and first exposed the females to smaller flies and then mated them with the larger ones.

To be sure that the was indeed due to something in the semen, Crean repeated the studies with an unfortunate group of male flies who had their genitalia glued down so they could not pass on any semen during their encounters. (“It’s horrifying but seemed nicer than cutting them off,” she says.) When these males, both large and small, were the first “mates” for females, their size did not have an effect on the offspring when the female mated with her second mate and had offspring. In other words, those offspring were large if the second male was large, and small if the second male was small.

Crean says the idea of a female’s previous mates having an effect on their offspring isn’t unheard of. In fact, this very idea, called telegony, was proposed by ancient scholars such as Aristotle but dismissed with the advent of genetics. But new findings about epigenetics — how our behaviors, such as diet, smoking and drinking — can affect our genes and how those changes can be passed on, make the idea of such non-genetic inheritance possible. “This could be seen as a maternal effect [such as diet or smoking] where the mother’s environment are her previous mating partners,” she says. “We have to realize that it’s not just DNA that gets passed on. It opens up the opportunity for all these other pathways that we had excluded.”

And while flies aren’t people, what are the chances that the same phenomenon is occurring in human reproduction? “It’s something we definitely don’t want to speculate about yet with humans,” she says. “There is no direct scientific evidence for that at all.” At least, for now.

TIME ebola

Ebola Patient in Texas Is Not Allowed Any Visitors

Thomas Eric Duncan remains in serious condition at a Dallas hospital

Thomas Eric Duncan remains in serious condition at Texas Health Presbyterian Hospital, kept under close watch by law enforcement officials. He’s not allowed any visitors, but is communicating with family and friends via phone.

In a news conference on Thursday, Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said CDC-trained health officials in Monrovia, Liberia, took Duncan’s temperature before he boarded a plane on Sept. 19 to begin his journey to the United States. As part of the screening process to prevent the spread of Ebola into this country, passengers’ temperatures are taken and those with fevers are pulled off the flight. Duncan’s temperature, according to Frieden, was 97.3 (or 36.3C) — normal.

Frieden said more than a dozen people from the countries most affected by Ebola were prevented from boarding flights to the U.S. in September. Duncan did not develop fever and symptoms until four days after he arrived in Dallas.

The four people in the apartment where he stayed are now under quarantine, prevented from leaving their home by a law enforcement officer stationed outside the complex. If any of the individuals violate the order, a formal court order will be issued. None of the people are symptomatic, but, said Dr. David Lakey, commissioner of the Texas Department of State Health Services, he “had concern about our ability to be confident that monitoring was going to take place the way we needed it to take place.” People who might have had contact with Duncan are being monitored with twice daily temperature checks and, he said, without elaborating on the reasons, “we felt this [quarantine order] was needed.”

Food is being delivered to the four people in the apartment and Lakey said a cleaning service had been found to thoroughly clean the residence as well. Health officials visited the apartment when Duncan was admitted to the hospital, and helped the residents bag Duncan’s belongings, along with trash and towels that he used. In an interview with Anderson Cooper 360° due to air Thursday evening, however, Duncan’s partner, Louise, with whom he stayed and is one of those quarantined, said the sheets he used were still on the bed. She and the other four people in the apartment were also instructed about how to decontaminate areas that Duncan might have touched, until more thorough cleaning could be done.

For now, Lakey said, “I have no intention to put other individuals under a control [quarantine] order.” Together with the CDC, the Texas health department is monitoring 100 people with daily temperature checks; most are unlikely to be at high risk of developing Ebola, and only about a dozen had direct contact with Duncan. The state is also investigating how Duncan could have been sent home after his first visit to hospital, when he had a fever and told the nurse that he had recently arrived from Liberia.

TIME Aging

How Moodiness and Jealousy May Lead to Alzheimer’s

Researchers say certain personality traits, like jealousy, worry, anxiety and anger, can double a woman’s chances of developing Alzheimer’s

We’re familiar with many of the brain-related factors that can contribute to Alzheimer’s disease—letting thinking networks go inactive, putting off exercise and healthy eating, having few social connections, enduring head injuries and genetic factors. But what about personality? Can the way you look at the world affect your risk of developing the neurodegenerative disorder?

Dr. Ingmar Skoog, professor of psychiatry and director of the research center on health and aging at the University of Gothenburg believes the answer is yes. In a paper published in the journal Neurology, he and his colleagues show that women with certain personality characteristics in middle age were twice as likely to have Alzheimer’s nearly 40 years later.

MORE: New Research on Understanding Alzheimer’s

“Getting Alzheimer’s disease is some sort of sum of a lot of different damages to the brain, and different things happening to the brain,” he says. “[Personality] is one of them.”

Specifically, a suite of features linked to what mental health experts call neuroticism showed the strongest connection to Alzheimer’s. Skoog and his colleagues tapped into a database of health information involving 800 women who were 38 years to 54 years old in 1968, when they filled in personality questionnaires and agreed to come in periodically to evaluate their cognitive functions. The personality evaluation placed women on a spectrum of neuroticism and extraversion; those showing more neuroticism included women who reacted more emotionally to events and experiences, worried more, showed lower self esteem and were more likely to express jealousy, guilt and anger. Those who were more extroverted showed high levels of trust, gregariousness and fewer emotional peaks and valleys.

MORE: New Insight On Alzheimer’s: What Increases Your Risk

At each of the four follow ups over the next 38 years, the women reported their stress levels—and women with higher neuroticism scores consistently showed higher levels of stress than those with lower scores.

Skoog believes that stress is the linchpin between the personality traits and Alzheimer’s dementia; previous studies have connected stress to dementia, and he says that the neuroticism characteristics are highly correlated to stress. “It seems like the personality factor makes people more easily stressed, and if people are more easily stressed, then they have an increased risk of dementia,” he says.

What’s more, when he controlled for the effect of stress, the association between neuroticism and Alzheimer’s disappeared, strengthening the idea that personality may lay a foundation for being more vulnerable to the effects of stress. Higher stress, particularly if it’s persistent as it is with certain personalities, can bathe the brain in hormones like cortisol. Those can damage blood vessels and cells in the brain that can then make Alzheimer’s more likely.

MORE: Scientists Are Getting Closer to a Blood Test for Alzheimer’s

The results hint that people can lower their risk of Alzheimer’s not just by keeping the brain active and improving social connections, as earlier work suggests, but by addressing stress-related personality factors as well. That, however, may require being aware of your later Alzheimer’s risk as early as during childhood, when personalities are forming. “Personality is something that occurs early in life, but you may be able to do something about it,” says Skoog. Especially when it comes to stress and how people respond to stress, interventions such as psychotherapy, for example, can help people to cope in healthier and less harmful ways.

He doesn’t believe that addressing stress and traits like jealousy and worry alone will protect a person from developing Alzheimer’s, but, he says, “it’s important to try to find as many factors as you can that contribute to common disorders. The more factors we can do something about, the more we can reduce risk quite substantially.”

TIME ebola

First U.S. Ebola Patient Identified

His sister identified him

The first patient to be diagnosed with Ebola in the U.S. was identified Wednesday as Thomas Eric Duncan.

Duncan’s sister Mai Wureh told the Associated Press it was her brother who is at the center of the country’s latest Ebola scare. Wureh said her brother went to the emergency room on Friday complaining of fever and a nurse asked about whether he had recently been in Ebola-affected countries. He said yes, but, according to Dr. Mark Lester, a clinical leader for Texas Health Resources, the “information was not fully communicated throughout the whole team.”

Duncan was sent home with antibiotics, and returned two days later in an ambulance with more severe symptoms. He is currently in serious but stable condition at Texas Health Presbyterian Hospital.

[AP]

TIME ebola

This Is the 21-Day Process for Stopping Ebola

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
Dr. Edward Goodman, epidemiologist at Texas Health Presbyterian Hospital Dallas, and Dr. Mark Lester, Southeast Zone clinical leader for Texas Health Resources, answer questions during a media conference at Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on Sept. 30, 2014 in Dallas. Mike Stone—Getty Images

Experts are tracking anyone who could have come in contact with the first patient to be diagnosed in the U.S.

U.S. health officials were working Wednesday to determine whether the first diagnosis of Ebola on American soil is an isolated case—or whether the patient may have infected others.

The Centers for Disease Control and Prevention (CDC) dispatched a nine-person epidemiology team to Dallas on Tuesday night. Their job is to contain any potential spread of the virus by working with local health officials to document whether the patient had contact with other people—who, where and when. How they’ll do this is less like the movie Outbreak and more of a labor-intensive process of interviews and monitoring.

The trail they will investigate starts Sept. 26, when a man came into Texas Health Presbyterian Hospital in Dallas for medical care. For two days, he had been feeling ill with fever and muscle aches—generally not concerning, which is why he was sent home. Two days later, he was worse, and was brought back to the hospital by ambulance.

It wasn’t immediately clear if doctors had asked the patient the critical question they should be asking all people who seek medical care for fevers, which is whether he had recently been outside of the U.S., and whether he had traveled to any of the countries in West Africa—including Guinea, Liberia or Sierra Leone—now battling the worst Ebola outbreak in the disease’s history. A Texas health official clarified Wednesday that a nurse had indeed asked the patient if he’d been to Africa and that he said he had, but hospital staff never factored that into their initial treatment.

MORE: How U.S. Doctors Can Contain Ebola

It turned out he had. Four days before he began feeling sick, the patient had been in Liberia before flying to the U.S. This time, based on his symptoms and his travel history, the doctors admitted him into an isolated room and called the state health department and the CDC’s 24-hour hotline; officials recommended testing the patient’s blood for the Ebola virus.

It tested positive, and now health officials from national and local agencies are on the scene. Their job is to contain any potential spread of the virus by documenting who, where and when the patient had contacted other people who might have been exposed via the patient. Because Ebola is only transmitted by droplets—in urine, blood or other body fluids—and only contagious when patients become symptomatic, those at highest risk are people who would have had the closest and most direct contact with the patient. Those who are exposed would also have to have direct mucous contact with infected fluids, such as via the eyes, nasal passages, or through a cut in the skin. So the passengers on the patient’s flights from Liberia to the U.S., for example, aren’t considered at high risk of exposure since he was not experiencing symptoms then.

MORE: Ebola in the United States: What You Need to Know

But the emergency medical personnel who brought the patient to Texas Health Presbyterian in the ambulance might be. They, and the man’s close family members, are being monitored for the virus’ longest incubation period—21 days—for any symptoms of Ebola, such as fever, nausea, vomiting or muscle weakness. If they don’t show any symptoms after that time, they’re likely in the clear.

Epidemiologists take a ring approach to tracing contacts of patients—starting with the circle of people with the most direct contact, such as family members or those who share close living arrangements. Each contact is asked about their own recent interactions with people, and this information is built into a contact tree of folks, not all of whom would be put on watch. Depending on how direct the contact with the patient was, even family members may not be quarantined but asked to refrain from traveling out of the city or country, for example, and avoiding public areas like movie theaters or shopping malls. A handful of children who were in the home with the patient are being monitored, local health officials said at a news conference on Wednesday, but they were allowed to attend school as usual.

MORE: Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

If anyone in the first circle of contacts develops symptoms, then doctors would step up their monitoring of the next ring of contacts, asking them to stay away from public gatherings for 21 days. This pattern continues until no one in a ring reports symptoms in the incubation period; that suggests they were not exposed and therefore don’t have the infection.

All of this, of course, depends on honest and accurate information from the patient and his contacts about where they have been and with whom—something that has been an issue in west Africa, where stigma against Ebola has led patients to flee health volunteers who are attempting to trace contacts, or fail to report people they have interacted with.

That shouldn’t be a problem here, CDC director Tom Frieden said. “We have identified all the people who could have had contact with the patient while he was infectious,” he said during a news conference. “We are stopping it in its tracks in this country. There is no doubt in my mind that we will stop it here.”

TIME ebola

How U.S. Doctors Can Contain Ebola

Ebola’s early symptoms look a lot like the flu or malaria. What are US doctors doing to distinguish Ebola from other diseases?

With the first case of Ebola diagnosed Tuesday in the U.S., doctors are on alert for other cases of travelers from the region who might be infected and bring the virus back with them to the States. But what are they doing and, perhaps more pressing, what should they be doing?

Officials at the Centers for Disease Control and Prevention (CDC) have been expecting such a case, given how mobile the world’s population is. So the agency has published guidelines to help doctors and hospitals distinguishing Ebola, particularly in its early forms, from the common flu or other infections.

Complicating matters is the fact that Ebola can take as long as 21 days to incubate, after which the first symptoms, including fever, muscle aches, nausea, vomiting and diarrhea, might send sick patients to the hospital or their local urgent care center. But fevers, especially in October in much of the U.S., generally mean the flu—and most doctors won’t think twice about recommending a flu shot (if the patient hasn’t already been vaccinated) and some fever reducing medication before sending a patient home.

That needs to change, say infectious disease experts and CDC officials. “Given the current outbreak, I think all U.S. hospitals should review processes for evaluating patients with fever,” says Ryan Fagan, who is leading the domestic infection-control efforts related to Ebola for the CDC. “It’s good practice to take travel histories.”

“Asking the questions takes literally five seconds for most patients,” says Dr. Mark Kline, an infectious disease specialist and physician in chief at Texas Children’s Hospital. “It’s quick and it’s easy, and for 99% of patients we see, if they say they haven’t traveled outside of the U.S. in the last 21 days, that’s the end of the Ebola discussion right there.”

At Patient First, a primary-care and urgent care facility in Virginia, Maryland, and Pennsylvania, CEO Dr. Pete Sowers has been preparing an Ebola plan that will now be put into place. Patients will be greeted with a sign at the entrance and at the registration kiosk asking them to notify the receptionist if they have recently traveled to Guinea, Liberia or Sierra Leone and have any of the symptoms connected with Ebola. A nurse then meets the patient at the reception area and interviews them briefly to determine if they have potentially been in direct contact with the virus and if so, guides them to the nearest hospital. All staff are also educated about how to screen for common Ebola symptoms that might otherwise be mistaken for something else, like the common flu.

Similarly, at the University of Texas hospitals in Houston, nurses and staff who register patients in the emergency rooms or any of the clinics are trained to ask patients if they have traveled outside of the U.S. in the past 21 days. If they have, patients are asked where they have been. If the patient has been in Guinea, Liberia or Sierra Leone, they are brought to a separate room where they are given surgical masks and where health care personnel wear protective equipment, including gowns, gloves and masks, when entering the room.

MORE: The 5 Biggest Mistakes in the Ebola Outbreak

Any hospital, no matter how small, has the capability of implementing such a system. Because Ebola is not an airborne virus, and can only be spread via direct contact with infected body fluids such as saliva, blood or other excretions, specially ventilated rooms aren’t necessary to contain infection and protect the rest of the hospital from getting exposed.

That’s why infectious disease experts are advising primary care doctors and those working at urgent-care clinics to adopt the same simple procedures: first asking patients about where they have been in the past month to triage those who are at highest risk of having Ebola, and also having a room ready for those who they suspect might be infected.

Even if they have recently traveled to the active Ebola areas in west Africa and have fevers doesn’t mean these patients harbor the virus. So far, says Fagan, hundreds of calls have come in to the CDC from local health departments about suspected cases of Ebola, and none, until the Dallas case, has been positive. Malaria and other infections also cause fevers that can last several days and make patients feel nauseous and weak. A quick look at a patient’s blood can reveal the malaria parasite under a microscope, and a relatively simple blood test can detect the genetic signature of the Ebola virus.

But it’s not practical nor necessarily helpful to run the Ebola test on every patient with a fever, says Fagan. Health departments and the CDC don’t have the resources to perform that many analyses, and even if they did, “if you test people who have low likelihood of having the disease to begin with, you start to run into problems with false positives since no test is perfect,” he says.

So here again, doctors have to rely on a much more labor-intensive but still effective technique: asking more detailed questions about their patients’ experience in the Ebola-stricken countries. Such as, did they have direct skin contact, or contact with the blood, urine, feces, saliva or vomit of an Ebola patient, or someone suspected of having Ebola? Did they have direct contact with the body of an Ebola patient during a funeral? Those patients would be at high risk of contracting Ebola, and would likely need a blood test to confirm presence of the virus. Doctors would take a blood sample and then call their local health department for testing, who would then notify the CDC, and both labs would likely perform analysis that looks for genetic signatures of the virus.

If the person had been in a home or health0care facility with Ebola patients, but didn’t have direct contact with them, they would be at medium risk of having the infection, and, says Fagan, public health officials would consult with the CDC to determine whether that person’s blood needed to be tested.

Despite the high death rate from Ebola in West Africa, health officials in the U.S. say that same toll is unlikely to be repeated here, since relatively easy infection control measures can be implemented in nearly every U.S. doctor’s office and clinic.

 

TIME Developmental Disorders

How to Improve a Baby’s Language Skills Before They Start to Talk

Researchers say playing a series of sounds when infants are four months old could speed up the way babies process language and make them linguistic stars when they’re older. How babies respond to the sounds can also predict which infants will have trouble with language as well

The first few months of a baby’s life come with a flurry of challenges on a still-developing brain. Sights, sounds, smells and touches as well as other emotional experiences flood in, waiting to be processed and filed away as the foundation for everything from language to emotions and how to socialize with others. What happens if things are not finding their right place in the brain during these critical months? Some research suggests it results in developmental delays later on—and that’s just what neuroscientist April Benasich and her colleagues from Rutgers University found in a new study, published in the Journal of Neuroscience.

Previous studies done by both Benasich and others show that the brains of children who learn to speak later or who develop reading disorders like dyslexia showed differences in detecting small differences in speech, such as the difference between da and ba, when they were infants. Other research has come to similar conclusions.

Genetic factors certainly play a role, but up to 10% of the babies Benasich has studied had no family history of developmental problems, yet still showed language trouble when they started talking. That’s why she turned to studying the brain maps of healthy babies before they learned to speak. These routes show how infants detect and respond to sounds in their environment—from words spoken to them to the humming of a dishwasher. In these early months, their brains are primed to sort out this cacophony of auditory stimuli and start making more refined distinctions between them. Doing so requires distinguishing between tiny differences, both in the sounds themselves as well as in frequencies. “Babies do this naturally; this is their job, since they want to be able to pick sounds out quickly and figure out whether they need to pay attention to them,” says Benasich.

For the babies in this study, she adorned them with skull caps studded with electronic sensors that would draw a map of their EEGs as they were presented with different, non-linguistic tones. Some of the babies were played sounds that changed ever so slightly, such as in their tone or frequency, and whenever there was a change, a small video in the corner of a screen they were looking at popped up. The babies naturally turned to watch the video, so the scientists used these eye turns as a signal that the babies had heard and recognized the transition in sounds, and were expecting to see the video. Another group of babies were played the same sounds but without the video training, and a control group didn’t hear the sounds at all.

MORE: Want to Learn a Language? Don’t Try So Hard

It wasn’t the sounds themselves that were important, but the changes in them that were key to priming the babies’ brains. Those who were trained to pay attention to the changes in the sounds, for example, showed more robust mapping of language sounds later on when they started to babble; by 18 months, these infants showed brain mapping patterns similar to those in two year olds. They were faster at discriminating different sounds, and quicker to pay attention to even tiny differences in inflection or frequency compared to babies who weren’t given the sounds. The babies who only listened to the sounds without the training fell somewhere between these two groups when it came to their language mapping networks.

Benasich says that the training lays the foundation in babies’ brains to become more efficient in processing language sounds, including very tiny variations among them. Their brains are setting up different neural routes for each sound, like a well-organized airport with separate runways designated for northbound and southbound flights. Other babies were less adept at this, essentially routing every sound through the same neural network, akin to sending every plane off the same runway, leading to delays as some have to bank and redirect in the opposite direction. In similar ways, says Benasich, in language, this cruder processing of sounds could result in delays in reading or speaking or language acquisition, and toddlers end up having to “manually” process the sounds in a more tedious and less automatic process. “Instead of automatically discriminating sounds without pausing, they have to stop and think and what that sound might be, and that leads them to hesitate a little,” she says. “That small hesitation makes a huge difference in how well they learn and process language.”

The training, she says, was minimal – the babies’ parents brought them in for six to eight minute sessions once a week for about six weeks. Yet she was “surprised by how robust the effects are for the babies.”

The study involved healthy babies who did not have risk factors for language disorders, so the training only helped them to enhance their later language learning. But the team is currently studying a group of babies at higher risk of having language deficits, either because of genetic risk factors or by having siblings affected by such disorders. If these babies show different brain patterns compared to those not at risk, then it’s possible that EEG patterns in response to sounds could predict which infants are at risk of developing language problems even before they start to talk.

Benasich is also working on developing her test into a parent-friendly toy that parents can buy and use with their babies; if their babies are developing normally, then the training can only accelerate and enhance their language skills later on, while for those who are struggling, the training could help them to avoid learning disabilities when they start school. It’s not possible to screen every baby, but if parents and doctors are able to take advantage of such a tool, then she hopes that more language-based disorders might be avoided. “Babies naturally do this, but for those who are having trouble, we are guiding them to pay more attention to things that are important in their environment, such as language-based sounds,“ she says. “We think we could make a huge difference in the number of kids who end up with learning problems.”

TIME medicine

For Back Pain or Headache, Painkillers Do More Harm than Good

Blue pills
Getty Images

For the first time, a major medical organization takes a stand on rampant overuse of opioids for treating back pain, headaches and migraines

Powerful painkillers do little to improve patients’ daily functioning, finds the American Academy of Neurology in a new position statement on opioid painkillers for chronic pain not related to cancer. Written by Dr. Gary Franklin, research professor in the departments of occupational and environmental health sciences and neurology at the University of Washington, the paper outlines the growing epidemic of overdose deaths—most of them unintentional—linked to opioid use. It concludes that in the majority of these cases, pain killers may ease some pain but fall short of truly improving patients’ health. Coupled with the potential hazards of addiction and overdose, the Academy says that doctors should be looking for other ways to help these patients manage their pain.

“This is the first position paper by a major American specialty society saying that there is a real problem here, and the risk might not be worth the benefit for certain conditions,” says Franklin.

MORE: Stopping America’s Hidden Overdose Crisis

The statement traces the rise of the opioid prescribing epidemic to loosening of previously strict regulations put in place in the 1940s, when opioid-based opium and heroin gained popularity as narcotic drugs of abuse. Recognizing the potential for addiction and overdose, states implemented rigorous controls over who could prescribe opioids and how much of the medications were dispensed; violating the rules meant doctors could lose their medical licenses or face criminal prosecution. Therefore, most physicians shied away from the drugs, leading to under-treatment of chronic pain, particularly among the growing number of cancer patients.

To address that trend, advocacy groups and pharmaceutical makers of opioids lobbied to change state laws to remove sanctions against doctors prescribing them—and ended up making them too lenient, says Franklin. “The language in Washington state, for example, said that no doctor shall be sanctioned for any amount of opioids written. So even if a doctor is handing out bags of opioids, it made it hard for the medical board or disciplinary board of the state to do anything about that doctor.”

MORE: FDA Approves New Pain Pill Designed To Be Hard to Abuse

That push to begin treating pain more aggressively began with cancer patients and those who were terminally ill, but drug makers saw another opportunity in people with chronic pain. The problem, say experts, is that for most such chronic pain, including low back pain, headaches and fibromyalgia, there is little evidence to support the idea that opiates are effective, and even less data suggesting that escalating doses and keeping patients on opioids for months or even years to treat persistent pain would benefit them. Most studies only followed patients for about a month on average.

Some in the pain community called out a red flag when they saw that a growing proportion of pain patients were still taking opioids but not reporting any improvements. In 2003, Dr. Jane Ballantyne and Dr. Jianren Mao, then at Massachusetts General Hospital and Harvard Medical School, published a review of the existing data on opioid use for chronic pain in the New England Journal of Medicine. It was among the first studies to highlight the fact that the skyrocketing number of prescriptions was doing little to actually reduce reports of chronic pain. “The real problem is physicians who are practicing with the best intentions and not understanding what the limited role of opiates is,” says Ballantyne, now a professor of anesthesiology and pain medicine at the University of Washington. “For 20 years they have been taught that everybody deserves an opiate, because they really don’t know what else to do. It’s a cultural thing and it’s hard to reverse that.”

The result, Franklin notes, is that since the 1990s, more than 100,000 people have died from opioid overdoses – more than the total number of American soldiers who lost their lives in the Vietnam War. In addition, studies have linked opioid use to serious health problems, from changes in hormone levels that can contribute to infertility, abnormal immune function, heart problems, and even worsening of pain symptoms.

MORE: Viewpoint: FDA Approval of Overdose Antidote Leaves Lives on the Table

Ballantyne says that the opioids can backfire in excessive doses; in the same way that neurons become over-sensitized to pain and hyper-reactive, high doses of opioids could prime some nerves to respond more intensely to pain signals, rather than helping them to modulate their reaction. “The idea is that we have the answer to all chronic pain, and that is to give opiates. That’s simply not true,” she says. “A lot of chronic pain isn’t appropriate for opiates.”

To stop the epidemic of deaths by opioids, Franklin says, states have to reinstate stricter oversight over doctors who prescribe these medications and implement guidelines that call for clear limits to opioid use that both doctor and patient agree upon, particularly for chronic conditions outside of cancer or terminal care. A handful of states and the Centers for Disease Control, for example, have already instituted so-called yellow-flag warning doses that require providers to get additional opinions if a patient reaches daily opioid doses of 80 mg to 120 mg and continues to complain of pain.

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But perhaps the best way to move the needle in the epidemic is to reset expectations that doctors and the public have about pain treatment. “In this country we expect everything to be fixed, and that doctors have the answer and can take pain away,” says Ballantyne. Yet many of the first strategies for alleviating pain might start with patients and their lifestyles rather than a prescription. Exercise and a healthy weight can ease much of the chronic pain associated with the back and joints, for instance. “We shouldn’t be resorting to pills as a first resort; they should very much be a last resort,” she says.

Alternative approaches to managing pain, including cognitive behavioral therapy, should also be given strong consideration. The Academy is urging insurers to step in and cover more such pain management approaches so that drug therapy doesn’t continue to be the default. “The important message is that we should not use opioids chronically for most people because they don’t work,” he says. “But at the same time we ought to be paying for things that do work.”

TIME Infectious Disease

Half of HIV+ Gay Men Don’t Take Life-Saving Drugs

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A pack of Nevirapine 200mg tablets of antiretroviral (ARV) drugs is pictured at the Sociedade Mocambicana de Medicamentos (SMM) Africa's first public factory for anti-HIV drugs on July 21, 2012 in Matola, Mozambique. AFP/Getty Images

The latest survey from the Centers for Disease Control (CDC) shows dramatic deficits in treatment among those at highest risk of HIV infection

Since the mid-1990s, powerful anti-HIV drugs have helped turn HIV-AIDS into a chronic condition as opposed to a death sentence. But in the latest report, published Thursday in the MMWR, health officials at the Centers for Disease Control and Prevention (CDC) show that nearly half of people who could be benefiting from the medications aren’t taking them. Only 49.5% of gay and bisexual men diagnosed with HIV receive treatment, and only 42% of those taking medication have been able to keep virus levels in their body down to undetectable levels.

Especially concerning is the fact that the vast majority of men diagnosed with HIV will, in fact, see a doctor about treatment. The trouble is, many do not follow through with treatment and check-ups. The disparity between who gets treatment and who doesn’t grows even starker among young and African-American gay and bisexual men, says David Purcell, deputy director of behavioral and social science in the division of HIV-AIDS at the CDC.

The reasons why men don’t get—or stick with—treatment range from cost to misperceptions about the toxicity of current drug therapies to the enduring stigma of HIV. As such, Purcell says the CDC is shifting its prevention efforts away from safe sex and condom campaigns—although those are still important—to focus more on people who are living with HIV. “We’ve gone full bore on this, and shifted our HIV prevention strategies to reflect the increasing evidence of the dramatic impact that treatment can have on prevention,” he says. “It’s very high on our radar.”

If HIV positive people start anti-HIV drugs as soon after their diagnosis as possible, they can reduce the amount of virus in their blood to undetectable levels and lower their chances of passing on HIV to practically zero.

Last week, the CDC announced its “HIV Treatment Works” campaign, aimed at educating HIV-positive people about the best therapies for them, and the “Start Talking Stop HIV” effort targeting gay and bisexual men, to encourage them to ask partners about their HIV status and get tested regularly.

Preventing HIV is not about one “best” method, he says, but the fact that prevention strategies work best together — such as using condoms and getting tested regularly, or knowing your status and taking HIV medications faithfully.

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