TIME Cancer

A Breakthrough Treatment for Lung Cancer Approved

What you need to know about this promising new drug

On March 5, a novel way to treat lung cancer won approval from the Food and Drug Administration (FDA). The latest drug, Opdivo, has showed promise with other cancers, and is the first to use the immune system to tackle hard-to-treat lung tumors. Here’s what you need to know.

How does the drug work?

Opdivo (nivolumab), made by Bristol-Myers Squibb, works the same way that releasing a parking brake frees a car to move. Normally, the immune system is held back from recognizing tumors as foreign and potentially harmful, since tumors are the body’s own cells that grow abnormally. Without such checks, “the immune system will destroy you,” says Dr. James Allison, chair of immunology at MD Anderson Cancer Center who discovered the first such brake that protected cancer cells from the immune system. But nivolumab releases this check on the immune system’s normally voracious appetite for anything it doesn’t recognize, so the body’s own defenses can preferentially recognize tumor cells as targets.

In the study submitted by the company to the FDA, 15% of patients showed some shrinkage or complete disappearance of their tumors.

MORE On the Horizon at Last, Cancer Drugs that Harness the Body’s Own Immune System

What makes this drug different from other cancer treatments?

Unlike surgery, chemotherapy, radiation or the anti-cancer drugs that interrupt specific signals that tumor cells use to survive, nivolumab doesn’t target the tumor itself. Rather it focuses on the environment in which the tumor lives, unleashing the immune system so it can recognize cancer cells more easily. “This drug doesn’t treat cancer; it doesn’t kill cancer cells so you can’t inject it and expect cancer to melt away immediately because it won’t,” says Allison. But when it’s combined with tumor-targeted treatments, what it could do is lower the risk of recurrent cancers by training the body’s T cells to recognize specific features of tumors, just as they do for viruses and bacteria, so the immune system can be alerted more quickly and efficiently to dispatch any returning or remaining cancer.

MORE A Shot at Cancer

Other drugs that work in different ways to unleash the immune system have also been approved by the FDA and more are in development.

How will this drug change lung cancer treatment?

While this drug was approved in 2011 to treat melanoma, the expanded approval to include non-small-cell lung cancer, the most common type of lung cancer, now means more patients can take advantage of the new, immune-based strategy to fight their disease. It also opens the door for other, next-generation immune therapies for treating the disease, which many experts thought would not be possible, given how aggressively lung cancer progresses. Now lung cancer patients who have failed other therapies and have no other treatment options have another shot at containing their tumors.

MORE Self-Sabotage: Why Cancer Vaccines Don’t Work

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TIME medicine

One Hour of Sleep Makes a Difference In What You’ll Eat

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When it comes to teens and sleep, it’s not how much sleep, but how consistently they sleep the same amount that’s important for their health

Plenty of studies have documented that teens don’t get enough sleep. They’re supposed to be in bed for eight to nine hours a night, but most get seven or less. Now the latest sleep research, presented at the American Heart Association EPI/Lifestyle 2015 meeting, shows when it comes to weight gain—which has been tied to sleep deprivation and disturbances—it’s not necessarily the amount of sleep that tips the scales but rather the consistency of that nightly rest.

Fan He, an epidemiologist at Penn State University College of Medicine, and his colleagues found a strong correlation between the variation in sleep patterns among a group of teens and the amount of calories they consumed. And for every hour difference in sleep on a night-to-night basis over a week, for example, they ate 210 more calories—most of it in fat and carbohydrates. Those with uneven sleep patterns were also more likely to snack.

Previous studies have linked poor or disrupted sleep to obesity; people not getting enough shut-eye, for example, may experience changes in the hormones that regulate appetite and how well they break down glucose in their diet. Levels of the hormone leptin, for instance, drop in those who are sleep deprived, and less leptin prompts the body to feel hungry.

MORE: The Power of Sleep

In the current study, however, all the teens got an average of seven hours a night, so it wasn’t as if some of the teens were sleeping for extremely long or short periods of time. Any metabolic changes they would have experienced due to their sleeping less than the recommended eight to nine hours would have been similar among the consistent and inconsistent sleepers.

Dr. Nathaniel Watson, president-elect of the American Academy of Sleep Medicine and co-director of the University of Washington Medicine Sleep Center, stresses that good quality sleep involves three things — getting enough sleep, making sure the timing of the sleep if appropriate, and avoiding sleep disorders. While the amount of sleep has gotten the lion’s share of attention in recent years, a new phenomenon called social jet lag, which the current study investigates, may deserve equal consideration. “We live in a society of yo-yo sleep in which people sleep less because of social or work demands, then try to catch up,” says Watson. “There haven’t been a lot of studies that looked at what kind of impact this has on our health, but teenagers may be particularly susceptible to social jet lag than older adults, and this study assessed that.”

MORE: This Is What’s Keeping Teens From Getting Enough Sleep

These results show that it was the variability in their sleep that was most strongly linked to their eating habits.

Why? The researchers guess that teens who aren’t sleeping consistently are more likely to get too little sleep on one night, for example, and therefore be more tired or sedentary the following day, which leads them to sit around and eat more. It may also be possible that teens with irregular sleep habits are more likely to stay up later on weekends; He found that these adolescents had a 100% higher chance of snacking on weekends compared to those who slept more regularly.

MORE: School Should Start Later So Teens Can Sleep, Urge Doctors

That suggests that health experts should focus not just on the amount of sleep teens are getting, but on their sleep patterns. “Instead of focusing on how much we sleep, we also need to pay attention to maintaining a regular sleep pattern,” says He. Such consistency, however, may not be so easy for teens to master.

 

TIME Heart Disease

Statins May Seriously Increase Diabetes Risk

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Statins can lower cholesterol and even tamp down inflammation to keep the risk of heart disease down. But these commonly prescribed drugs may increase the risk of diabetes, and by a considerable amount

Doctors may have to weigh a serious potential risk before prescribing statins, the cholesterol-lowering drugs that are among most prescribed drugs in America. In a study published in Diabetologia, scientists from Finland found that men prescribed statins to lower their cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. What’s more, the statins seemed to make people more resistant to the effects of insulin—which breaks down sugar—and to secrete less insulin. The impact on insulin seemed to be greatest among those who started out with the lowest, and closest to normal, levels of blood glucose. And the higher the dose of the statin, and the longer the patients took them, the greater their risk of diabetes.

Previous studies have suggested that statins can raise blood sugar levels, and increase the risk of diabetes by anywhere from 10% to 20%, but none have documented an effect this large. Doctors often consider statins for patients who are at higher risk of heart disease, and one of the risk factors for future heart trouble is diabetes. So how do these results affect that decision?

“It’s a good news-bad news scenario,” says Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado School of Medicine. “Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued [from statins] in reducing risks of heart attack, stroke and fatal heart disease trumps the effects of being new onset diabetics.”

In other words, the good that statins can do for people who are not yet diabetic but at higher risk of heart problems outweighs the increased risk of diabetes.

MORE New Guidelines for Cholesterol Treatments Represent “Huge Change”

And while the increased risk that the Finnish scientists found — 46% — is noteworthy, Eckel points out that the study involved only white men, and therefore may not be generalizable to a broader population. It’s not clear what the men’s family history or personal history of diabetes was; some may have had other risk factors for the disease that put them at higher risk of developing diabetes anyway, even if they didn’t take a statin.

Those who developed diabetes while taking statins were similar on many metabolic measures to those who developed diabetes but weren’t taking statins, suggesting that “that statin treatment increased the risk of diabetes independently of the risk profile of the background population,” the authors write. In a separate, U.S.-based study on statins, researchers found that those who went on to develop diabetes while taking statins also had risk factors for the disease before they started taking the medications.

MORE Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

Which means that for confused patients, and their doctors, the current advice about who should take statins doesn’t change. The results, in fact, highlight the need for a discussion rather than just working through a checklist before prescribing statins. For patients who may not yet be diabetic, but are vulnerable to developing the disease and also may need a statin, Dr. Neil Stone, lead author of the 2013 American College of Cardiology and American Heart Association cholesterol guidelines, says he stresses the importance of lifestyle changes in diet and exercise.

“If you have a patient who is prone to developing diabetes, you’re getting into a higher risk group, because they also have risk factors associated with heart disease. So they have the potential to benefit from statins. If they are going to take a statin, I tell them we are going to help you get more fit, and work with your lifestyle. It’s even more important because if you don’t do that, and the patient decides to take the statin and go on with their unhealthy habits, then they are going to be even more prone to developing diabetes,” says Stone.

The patient’s family history of diabetes is another important part of the decision to start someone on a statin. It’s all about making sure that each patient’s risks and benefits are weighed carefully. And the potentially greater risk of diabetes created by statins should be part of that consideration. “Communication here is everything,” says Eckel.

Read next: New Hormone Discovered That Curbs Weight Gain, Diabetes Just Like Exercise

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TIME Diet/Nutrition

The Weird Benefit of Eating Salty Food

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Too much salt can lead to heart disease, but there may be a healthy side to salt that hasn’t been appreciated — until now

If you’re an average American, chances are that you’re eating too much salt. But the latest research — which, the scientists stress, is still in its early stages — hints that there may be some benefits to salt that have gone unnoticed. Salt, it seems, may be an ancient way for the body to protect itself against bacteria.

Reporting in the journal Cell Metabolism, Jonathan Jantsch, from the University of Regensburg in Germany, says that salt may be an effective way to ward off microbes. In a series of studies using both mice and human cells, he and his colleagues found that levels of sodium go up around an infection site, and that without salt, bacteria tend to flourish and grow better.

MORE Older Adults May Be OK to Eat More Salt Than Previously Thought

The discovery came about by accident, after Jens Titze, the study’s senior author, noticed that mice who had been bitten by their cage mates showed higher levels of sodium in their skin than those who were wound-free. Jantsch decided to find out whether the salt had something to do with the infection-fighting functions of the immune system.

He and his team conducted a series of experiments in which they subjected mouse and human cells to high levels of sodium chloride, and watched the immune cells activate. They also fed mice diets that were low and high in sodium, and then infected them with Leishmania major. The mice fed the higher amounts of sodium showed stronger immune responses to the wounds, and cleared their infections faster than the mice eating less salt. In fact, Jantsch speculates that certain skin cells may transport sodium preferentially to sites where bacterial populations are high in order to create another barrier preventing the microbes from entering deeper into the body.

That opens the possibility that salt may be an unrecognized contributor to the immune system, and possibly a remnant from the days before antibiotics, when mammals, including humans, needed some allies in the fight against microbes. After all, salt has been used for centuries to preserve food from spoiling in bacteria’s presence, so it makes sense that evolutionarily, sodium might have also been co-opted by the body in a similar way. “I really think salt is an unappreciated factor of immunity,” says Jantsch.

MORE New Dietary Guidelines: Cut Salt and Sugar, Eat More Fish

If that’s the case, then it may be possible to take advantage of salt-based dressings, for instance, to improve wound healing. Burn patients may benefit the most, since their skin, the first line of defense against microbes, is compromised. And for those with hyperactive immune responses, dialing down the concentration of sodium at specific areas might also be helpful. “We are interested in how this works, because it can have broad applications,” says Jantsch. “We can possibly target and boost sodium in situations where we need more salt if it’s deficient, and lower it in situations where there is salt overload and hypertension.” Already, some companies have produced wound dressings with enhanced sodium concentration as a way to help infections heal faster.

MORE Salt Doesn’t Cause High Blood Pressure? Here’s What a New Study Says

He stresses, however, that the results don’t mean high salt diets are now healthy — or advisable. His studies, even in mice, haven’t worked out exactly how salt in the diet affects the body’s ability to recruit the nutrient to fight infections. And to get the bacteria-fighting effect, the mice were fed a diet that was extremely high in sodium — 4%, compared to the average mouse chow which is only 0.2% to 0.3% sodium. “There is overwhelming data that tells you a high salt diet is detrimental to the heart,” he says. “We used one animal approach to look at the beneficial role of salt. So I would be hesitant to draw any conclusions for humans at this stage.” He and others are already setting up more experiments, however, to study how salt might become the next weapon in fighting infections.

MORE FDA Wants to Limit Your Salt Intake. Is That a Good Thing?

Read next: 11 Bad Habits That Bloat You

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TIME neuroscience

Alzheimer’s Protein Found in Young Brains for the First Time

The brain-damaging protein in Alzheimer’s disease may start accumulating as early as in our 20s

For the first time, scientists have found evidence of a protein found in Alzheimer’s disease, called amyloid, in the brains of people as young as 20.

In a report published in the journal Brain, Changiz Geula, a professor at the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University Feinberg School of Medicine, reveals that the protein—which gradually builds up and forms sticky plaques in the brain in Alzheimer’s disease—starts appearing early in life. Amyloid is normally made by the brain and has important functions; it’s an antioxidant and promotes the brain’s ability to remain adaptable by forming new connections and reinforcing old ones, especially those involving memory. But in some people, the proteins start to clump together with age, forming sticky masses that interfere with normal nerve function. Eventually, these masses kill neurons by starving them of their critical nutrients and their ability to communicate with other cells.

MORE: New Research on Understanding Alzheimer’s

When Geula compared the autopsy brains from normal people between ages 20-66 years, older people without dementia between 70-99 years, and people with Alzheimer’s between 60-95 years, they found evidence of amyloid in a particular part of the brain in all of them. That region isn’t normally studied in Alzheimer’s, but it plays roles in memory and attention.

The results show that the process responsible for causing Alzheimer’s begins as early as in the 20s, and it also pointed to a population of cells that are especially vulnerable to accumulating amyloid—essentially serving as a harbinger of future disease. “There is some characteristic of these neurons that allows amyloid to accumulate there more than in other neurons,” says Geula. “At least in this cell population, the machinery to form aggregates is there.” Reducing the amount of amyloid in the brains of young people might help halt the formation of Alzheimer’s, he says.

MORE: This Alzheimer’s Breakthrough Could Be a Game Changer

Because the study involved autopsy specimens, there’s no way to tell whether those younger individuals would have gone on to develop Alzheimer’s. But they provide a clue about the early steps behind the disease.

They may also shed light on one way to prevent, or at least minimize, the effects of Alzheimer’s. Experts currently believe that the memory-robbing condition occurs when the balance between the production of amyloid and processes that clear the protein from the brain veer out of balance with age. As more amyloid is left in the brain, it tends to become stickier and adhere to other amyloid fragments, eventually forming damaging plaques. Geula believes that even in people with a genetic predisposition to forming these sticky plaques, removing amyloid as early as possible can slow down the progression of the disease. While there aren’t any effective ways to do this yet, there are promising compounds currently being tested in clinical trials. And given Geula’s findings, those studies become even more critical as a way to help more people to treat and even prevent the disease.

MORE: New Test May Predict Alzheimer’s 10 Years Before Diagnosis

The key, as the findings show, is to start early. “If you can get rid of the background [amyloid], then it can’t do anything,” says Geula.

TIME vaccines

Many Doctors Give In When Parents Want to Space Out Vaccines

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The vast majority of doctors don’t believe that spacing out childhood immunizations is a good idea, but they’re doing it anyway. Here’s why

It’s an eye-opening survey, to say the least, and its findings are clear: Nearly all — 93% — primary care doctors and pediatricians surveyed say that in a typical month, parents ask them to deviate from the recommended childhood immunization schedule and instead give the shots over a longer period of time, according to a report published Monday in the journal Pediatrics. And while nearly 90% thought that such spacing out of the immunizations would put the children, and the community at risk of spreading infectious diseases like measles, 37% said they agreed to do so often or always. That was a 131% increase since the last survey, conducted in 2009, when only 16% said they agreed to changing the recommended vaccine schedule.

“Doctors are feeling really conflicted because they overwhelmingly think this is the wrong thing to do, and is putting children at risk, but at the same time, they want to build trust with their patients and meet people halfway,” says Dr. Allison Kempe, professor of pediatrics at University of Colorado and Children’s Hospital Colorado, who is the lead author of the study.

MORE How Safe Are Vaccines?

Even more concerning, she says, is the fact that 40% of the physicians said that the vaccine issue was the source of their job dissatisfaction. The survey also asked them about different strategies the doctors employed with parents to discuss the importance of following the existing vaccination schedule, but the doctors revealed very little confidence in those methods. In fact, the strategy they believed worked most often only garnered a 20% effectiveness rating, and that was telling parents that the doctors immunized their own children according to the recommended schedule.

“It’s a terrible conflict when I have to make a decision when I’m doing my vaccine orders for a particular child and decide if it’s going to be the pertussis vaccine for that infant or the Hib or the pneumococcal,” says Dr. Julie Boom, director of the immunization project at Texas Children’s Hospital and associate professor of pediatrics at Baylor College of Medicine, of the decision she has to make when parents insist on giving their babies only one immunization during a visit. While Boom makes every effort to discuss with parents the importance of sticking with the recommended immunization schedule, she says “I will offer the vaccine at that visit and explain the risks and benefits of the decision that parent is making and try to get them to come back as quickly as possible to take the next vaccine so the baby will be fully vaccinated as on time as possible.”

MORE Childhood Vaccines Are Safe, Says Pediatrics Group

But she does that knowing that the baby leaves her office at higher risk of potentially getting sick since he is not fully immunized. “The baby leaving my office is at risk of getting the illnesses for which he’s not vaccinated,” she says. “To know I’m going to pick one [vaccine] and leave the other behind, despite all the time I spend explaining the risks and benefits to the parents—it’s very difficult for me.”

And it’s increasingly a problem for her colleagues as well. While parents who refused to vaccinate their children gained the most media attention in recent years and likely contributed to pertussis and measles outbreaks, even more parents – about 13% — used an alternative vaccine schedule that included delaying some of the shots. These parents often express concern about “overloading” their babies’ immune systems with too many shots in one visit (the most that infants generally get are five, at the year-old visit). In the survey, 35% of doctors said they realized that allowing parents to delay shots sent mixed messages; parents could interpret the action as proof that the existing schedule wasn’t so important after all if doctors ended up changing it.

Part of the conflict may come from the advice from organizations to which these physicians turn for help. As some frustrated doctors began to “fire” their patients and refuse to see them if they declined to vaccinate their children or asked for alternative immunization schedules, in 2005, the American Academy of Pediatrics advised its members to not dismiss those parents and urged them to discuss and educate them instead about the importance of vaccinations and of getting them on time. That may explain why 82% of doctors in the current survey said they felt agreeing to delaying some vaccines would build trust with their patients; 80% said that if they refused to accommodate the parents wishes, these parents would leave to find some doctors who would.

MORE Nearly One in Ten Americans Think Vaccines Are Unsafe

“Nobody is in favor of dismissing patients, but I think we need to get a little bit straighter about communicating to these parents about how strongly we feel about vaccinations, and how detrimental spacing them out is for their child,” says Kempe.

Among the most commonly used strategies to convince parents, doctors cited their comfort with vaccinating their own children according to the schedule, stressing that spacing out vaccines puts their children at risk of getting sick, reminding them of recent outbreaks of vaccine-preventable diseases, and explaining that alternative schedule haven’t been studied for their safety. Doctors have even informed parents that bringing their child back for multiple visits to get jabbed with a shot can be more painful for the baby. None were rated by the physicians as being more than 20% effective, leaving doctors at a loss.

MORE Dr. Tom Frieden: Vaccines Can Prevent Measles From Being a Disease of the Future

That’s why professional organizations should take a stronger role in providing doctors with more guidance about what may work and what doesn’t. Conducting more studies on different methods of educating and addressing parents concerns could arm doctors with more data and scientific evidence to back up their belief in the established immunization schedule, for example. Kempe also notes that starting to educate parents earlier, such as during pregnancy, may help to reinforce their comfort with vaccines and what they can do to protect their baby once he is born. And reaching parents and parents-to-be on a more consistent basis may also be key to alleviating their concerns about vaccines. “We as doctors have not exploited mass media or the kinds of media that the anti-vaccine movement has,” says Kempe. “We are not doing a great job of countering the misinformation out there, and also not doing a good job of enlisting parents who are pro-vaccine in a proactive way to establish a social norm.”

Part of that has to do with the fact that the time that doctors typically have with parents during well-baby visits is short. Most doctors reported having to spend at least 10 minutes with parents to address their vaccine concerns; that’s about half of the time of an average visit, which also has to cover other important wellness issues such as nutrition, car safety, and more. So Kempe says other strategies, such as group visits or sessions to address vaccine questions specifically, or designated staff at family practices or pediatricians’ offices who are assigned the task of answering questions about vaccines and vaccine safety might be more effective. In Boom’s practice, she often schedules a separate visit for parents to discuss just their vaccine questions, so she doesn’t feel rushed to come to a decision about whether to help the parents space out vaccines or not.

For Boom, the key is understanding where the parents’ concerns come from. “For one parent it may be about long term effects of vaccinations, and for another it may be something else,” she says. “You have to understand where the misinformation is coming from, and then very specifically address each parent’s questions. It does take time.”

Using this strategy, Boom feels she is relatively successful in educating parents about the need to follow the recommended vaccination schedule. But she admits that working in an academic institution, she has the luxury or more time with her patients.

For those that don’t, it’s clear that frustration is reaching a boiling point in doctors’ offices. “I hope this study is a wake-up call, and I hope it’s time to say ‘okay, what we are doing isn’t working,’ and start asking ‘what should we be doing?’” says Kempe.

Read next: I Was on the Front Line of L.A.’s Last Measles Outbreak

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TIME Diet/Nutrition

Better Grocery Stores Alone Can’t Improve Kids’ Diets, Study Finds

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Even if you build them, they won’t come, says the latest study on finding ways to get more healthy foods to young children

There’s been a lot of talk lately about food deserts and lack of access to healthy, nutritious food for many families living in rural and lower-income urban areas. So the solution seems to be to increase the availability of healthier fare, and what better way than to build a full service supermarket in the neighborhoods without one?

That’s what a government-sponsored program called Health Food Financing Initiative does, enticing supermarket chains to build stores in lower income areas with favorable tax credits. These stores are also required to meet some criteria meant to make the most of their presence in areas where fresh and nutritious foods are harder to come by. In New York, for example, the state program requires that at least 30% of a store’s floor space be devoted to perishable foods like produce and fruit, with at least 500 square feet dedicated specifically to fresh produce.

MORE: How the Nation’s Nutrition Panel Thinks You Should Be Eating

A new study published in journal Public Health Nutrition looked at whether the supermarkets are actually making a difference. Brian Elbel, associate professor of population health and health policy at New York University School of Medicine, and his colleagues compared eating habits in families in a part of the Bronx with a new supermarket and in a close by neighborhood without one.

To capture any change in the families’ food-buying habits over time, the researchers stopped parents on the street in these neighborhoods and asked them questions about their eating and food buying patterns, and then called the participants around six months later, and again a year after that first encounter.

The results were sobering. While there was an increase in those who said they shopped at the supermarket between the first and second rounds of questioning, that difference disappeared a year later. What the families were buying also didn’t change much, despite the supermarket selling fresh and healthy foods. At the start of the study 77% of those living in the neighborhood with the new supermarket said they had fresh fruits and vegetables in their homes, which dropped to 68% by the second follow up. The other neighborhood, however, showed a similar decline, from 78% to 65%.

MORE: Most Schools Still Don’t Meet Federal Nutrition Standards

In fact, both neighborhoods showed similar changes in food-buying trends, including positive ones such as a decrease in the availability of cookies, cakes, pastries and salty snacks in the home, so Elbel says it’s not possible to attribute them to the presence of the supermarket in the one community.

“It’s very clear that a supermarket alone does bring access to healthy food,” says Elbel. “But at the same time, does it bring unhealthy stuff, and introduce new products to the neighborhood that weren’t there before? Potentially.”

While healthy foods were available at the store, for example, they were not always the most affordable items, or the ones that the store promoted with special discounts or deals. Cost, it seems, overrules nutrition for many families making food-buying decisions.

While programs to increase the availability of full service food stores are laudable, Elbel says his results highlight the fact that access isn’t the only answer. “We can definitely imagine criteria that would make it more stringent for stores to qualify for these programs, and provide more detail on how the store is structured, what products are promoted or which products are available and how they are priced,” he says. “The question is, if we provide the tax credits and these constraints, will stores still be interested in opening in [food desert] neighborhoods? I don’t know.”

MORE: Nearly 60% Of People Use Nutrition Info on Menus

It’s also possible that the supermarket didn’t have the impact public health officials anticipated because the neighborhoods already had reasonable access — a train or bus ride away — to full service stores, before the new store opened. Almost 90% of the participants said they shopped at a supermarket, not convenience stores, for meals they made at home, so the new store likely didn’t do much to change that pattern. That suggests, says Elbel, that policy makers may also need stricter definitions of food deserts or areas that need nutritional attention.

“Just building a supermarket is not enough,” he says. “We need more data on what exactly a food desert is, and exactly where to place a supermarket. We have to look at access more broadly, and make clear that improving health is not just about access.” That’s a bigger challenge, but as the study shows, needs to be addressed if healthier fare is going to find its way onto more dinner plates.

TIME Reproductive Health

How a Baby Was Born Encased in an Amniotic Sac

Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical Center Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

The physician was so surprised that he snapped a photo on his phone

Correction appended

Silas Johnson is barely a day old and is already an internet sensation. The Los Angeles infant was born three months early, and was remarkably still completely encased in his amniotic sac, making it appear as if doctors delivered a large bubble with a tiny baby inside.

Johnson was born at Cedars-Sinai Medical Center via C-section, curled in the hallmark fetal position within, and his hands were visible pressing against the clear membrane of the sac. His physician was so surprised by the rare birth that he snapped a photo on his cell phone while his team rushed to ensure that the baby’s breathing and heart rate were normal.

The sac is the baby’s home during gestation, filling with fluid to cushion him during pregnancy. Just before birth, it normally ruptures — the so-called ‘water breaking’ that signals an expectant mom that labor is underway. (In cases where the water doesn’t break, doctors can puncture the sac to release the fluid.) In Cesarean sections like this one, doctors frequently pierce through the sac as they make their incision to remove the baby.

Silas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at  on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical CenterSilas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children’s Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

In vaginal births, the sac remains in the mother as part of the placenta, and isn’t released until the placenta is removed in the afterbirth. But in some births, parts of the sac follow the baby through the birth canal.

While seemingly unusual, births ‘en caul,’ in which the infant remains entirely inside the sac during the journey through the birth canal, can be intentional, particularly when the baby is premature. Dr. Amos Grunebaum, director of obstetrics at NewYork-Presbyterian Weill Cornell Medical Center, purposefully delivers some of his babies in the sac, as a way to protect them during the delivery process. “It protects the baby from being injured; it serves as a cushion around the baby.”

Amniotic sacs and its fluid are connected to the placenta, which provides oxygen to the baby. So as soon as the baby is born, the sac must be ruptured to help the baby breathe.

“There are a lot of myths surrounding en caul births,” says Grunebaum. “There are many, many difference sources in the literature where people think the person delivered that way has certain powers.”Johnson’s mother Chelsea isn’t worried about that, but told CNN after seeing her doctor’s picture that “Silas, you’re a little special baby.”

Correction: This article originally misstated the baby’s last name. It is Johnson.

Read next: How to Parent Like a German

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TIME neuroscience

A Simple Skin Test May Detect Alzheimer’s

There’s new hope that the first signs of these brain disorders may lie in the skin

Detecting Alzheimer’s and Parkinson’s diseases as early as possible is critical. But while doctors know that the conditions can start 15 to 20 years before the symptoms appear, there aren’t many reliable ways of pinpointing exactly when that occurs. Now, scientists led by Dr. Ildefonso Rodriguez-Leyva at Central Hospital in University of San Luis Potosi in Mexico report that the skin may hold the clue to such early detection.

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In a study that will be presented in April at the American Academy of Neurology’s annual meeting in Washington, D.C., Rodriguez-Leyva found that compared to healthy patients and those with age-related dementia, patients with Alzheimer’s and Parkinson’s diseases had seven times higher levels of an altered form of a protein called tau in skin biopsies, and Parkinson’s patients also showed seven to eight times greater levels of a harmful version of another protein known as alpha-synuclein. Researchers aren’t sure what alpha-synuclein’s role is in the brain, but in Parkinson’s patients, it tends to clump into harmful aggregates that interrupt normal nerve function. Tau is involved in the brain decline associated with Alzheimer’s; as nerve cells die, the normally aligned molecules of tau, which function like railroad tracks to transport nutrients, collapse, twisting into unorganized masses of tangled protein.

“This skin test opens the possibility to see abnormal proteins in the skin before central nervous system symptoms — cognitive or motor deficits — appear,” Rodriguez-Leyva says.

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Rodriguez-Leyva turned to the skin to look for signs of the altered brain proteins since the skin and brain share a common embryonic origin; while everyone makes the two proteins, those who go on to develop Alzheimer’s or Parkinson’s seem to be especially vulnerable to having them fold in abnormal ways and stick together in damaging masses in the brain. If there were genetic signals dictating these sticky forms of the proteins, he speculated, then those signals might be detectable in the skin as well. “The ectoderm originates the nervous tissue and the skin,” he writes in an email to TIME discussing the study. “Our idea is that they have a similar program of protein expression. Therefore the skin could reflect events taking place in the nervous system.”

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The study involved only a few dozen patients — 20 with Alzheimer’s, 16 Parkinson’s patients and 17 with age-related dementia, who were compared to 12 healthy controls — so more work needs to be done to confirm the findings. But the results hint that it may be possible to detect these neurodegenerative conditions sooner, and it also provides drug developers with more confidence that targeting abnormal forms of tau and alpha-synuclein may lead to effective treatments.

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