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.

MORE: FDA Expands Access to Overdose Antidote to Stem Opiate Addiction Epidemic

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

MOZAMBIQUE-BRAZIL-HEALTH-AIDS
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.

TIME ebola

FDA Cracks Down on Unproven Ebola Cures

Ebola virus
Getty Images

The agency says a product marketed as a treatment for Ebola violates laws that require drugs to be approved by the FDA for safety and effectiveness

On Sept. 23, the Food and Drug Administration (FDA) issued a warning letter to Rima Laibow and Ralph Fucetola of Natural Solutions Foundation informing them that the company’s products, including Silver Sol Nano Silver and High Potency CBD Hemp Oil, which are marketed as Ebola treatments, violate the Federal Food, Drug and Cosmetic Act.

Based on the claims made on the company’s website as well as in a YouTube video, the FDA says the products are marketed as drugs, and therefore fall under the agency’s jurisdiction.

In the letter, the FDA notes

Your “Personal Protection Pack,” “Family Protection Pack,” “Dr. Rima Recommends™ The Silver Solution,” and “CBD Organic Dark Chocolate Bars” products are not generally recognized as safe and effective for the above referenced uses and therefore, these products are “new drugs” under section 201(p) of the Act [21 U.S.C. § 321(p)]. New drugs may not be legally introduced or delivered for introduction into interstate commerce without prior approval from the FDA, as described in section 505(a) of the Act [21 U.S.C. § 355(a)]; see also section 301(d) of the Act [21 U.S.C. § 331(d)]. FDA approves a new drug on the basis of scientific data submitted by a drug sponsor to demonstrate that the drug is safe and effective.

The company’s claims about its Ebola treatments also violate Federal Trade Commission laws, which prohibit advertising that a product can prevent, treat or cure human disease without reliable and valid scientific evidence.

In the past month, the World Health Organization as well as the FDA have warned consumers about such unproven therapies. Both remind the public that there are no known cures or treatments for Ebola; the therapy received by a handful of care workers in the U.S. are still considered experimental and only used as an exception to the agency’s usual drug approval process.

The company has 15 days to correct the violations, or face legal action and seizure of the products.

TIME Developmental Disorders

How Brain Waves May Be the Clue to Diagnosing Autism

Unique EEG fingerprints reveal how autistic brains process sights and sounds

Diagnosing autism as early as possible, even before the first noticeable symptoms of social and developmental delays emerge, is becoming a critical strategy for reducing the condition’s most severe symptoms. Experts have long known that children with autism process sensory information – sights and sounds in particular – in different ways than unaffected children.

In a new study published in the Journal of Autism and Developmental Disorders, Sophie Molholm, from the departments of pediatric and neuroscience at Albert Einstein College of Medicine, proposes that those differences may lay the foundation for social and communication deficits in some children later on.

Molholm and her team took electroencephalogram (EEG) readings from more than 40 children aged six years to 17 years diagnosed with autism and compared their patterns to those of unaffected children of similar age and other characteristics. All children were given either a flash cue, a beep cue or a combination of both, and asked to press a button when these stimuli occurred. A cap with 70 sensors picked up the children’s brain responses every two milliseconds during these tasks, including those that recorded how the brain first processed the sensory information.

MORE: Behavior Therapy Normalizes Brains of Autistic Children

The children with autism showed a distinctly different brain wave signature from those without the condition. Specifically, the signals in those with autism showed differences in the speed in which the sights or sounds were processed, and in how the sensory neurons recruited neighbors in more far-flung areas of the brain to register and make sense of the information. And the more abnormal this multi-processing was, the more severe the child’s autistic symptoms. “By developing this tool in the older cohort of children we can then figure out which ones are the most promising and then go test them in younger children,” says Molholm.

It’s also possible that because the children she studied were older, the differences in their EEG patterns were the result of autism, rather than a sign of changes that precede the disorder. But, she says, “If you ask me to make an educated guess, I would say these are part of autism, and they represent neuropathology related to having the disorder. It seems unlikely to me that you get autism and then develop atypical auditory processing.”

MORE: Autism Symptoms Disappeared With Behavioral Therapy In Babies

Molholm says the sample was too small to use the profile for diagnosing autism, but it could lead to such a test if the results are confirmed and repeated. To confirm the findings, scientists will have to intervene with behavioral strategies for helping the different regions of the brain work in a more coordinated way when confronted with visual and auditory cues. If that reduces autism symptoms, then EEG profiling could become one of a number of new ways that doctors can start identifying those at highest risk – however young — of developing autism.

TIME health

Obama Plan to Fight Antibiotic Resistance ‘Disappointing,’ Critics Say

Publix First To Offer Free Antibiotics To Customers
Roxana Selagea, a Publix Supermarket pharmacy manager, counts out the correct number of antibiotic pills to fill a prescription August 7, 2007 in Miami, Florida. Joe Raedle—Getty Images

The President’s plan to address the growing health threat of bacteria that are resistant to antibiotics doesn’t go far enough, say some, in containing the heaviest users of the drugs – agriculture.

President Barack Obama is taking the health problems posed by antibiotic resistant bacteria seriously. He signed an Executive Order Thursday to create a task force – led by the secretaries of Defense, Agriculture and Health and Human Services – to develop an action plan on the issue. He also created a non-governmental advisory council to inform and develop recommendations concerning antibiotic resistant bacteria, and directed the Food and Drug Administration (FDA) to “continue taking steps to eliminate agricultural use of medically important antibiotics for growth-promotion purposes.”

That last action will likely become the most important, given that 80% of antibiotics in the country aren’t used by people but by animals. So while over-prescribing of the drugs to treat everything from colds to viral infections (for which they aren’t effective) are part of the problem, their use in animals, which can then pass the resistant strains on to people, is the much bigger challenge. And most of the animals receiving antibiotics aren’t sick, but are fed low doses of the drugs in order to grow faster and larger.

MORE: Farm Drugs: The FDA Moves to Restrict (Somewhat) the Use of Antibiotics in Livestock

In 2012, the FDA did restrict the use of one class of antibiotics commonly used in people, cephalosporin drugs, in animals that weren’t actively fighting infections. It also called for makers of antibiotics to voluntarily phase out claims that the medications would enhance growth, and pushed for greater veterinary oversight of antibiotic prescriptions.

But earlier this year, the Natural Resources Defense Council (NRDC) revealed evidence that the FDA allowed 18 antibiotics that it rated as high risk to human health to remain on the market, where farmers used them to boost the feed and water of their animals.

MORE: New Report Says FDA Allowed ‘High Risk’ Antibiotics to Be Used on Farm Animals

And, as Mae Wu, an NRDC attorney who wrote a blog post about the need to address farm practices, says, while animal drug makers may be removing growth claims about their products, they may still be touting their “disease prevention” features. So “they can easily switch from one to the other without changing practices,” says Wu. “It’s a change in name only.”

That’s why Wu argues that the President’s actions, while important, aren’t enough to change such long-standing agricultural practices.

“It’s great that the President has elevated [the problem of antibiotic resistance] to this level, and the White House is really talking about the problem and developing a plan over the next five years about how to do it,” she says. “But it’s disappointing that they are being so passive on one of the largest issues – the largest use of antibiotics in this country [in agriculture].”

The President’s Council of Advisors on Science and Technology (PCAST) also released a report on the matter, and among its eight recommendations for combating antibiotic resistant is a call for limiting the use of antibiotics in agriculture.

What that means will be up to the task force to determine, since the report didn’t specify a strategy. Even if the latest presidential actions don’t change the way antibiotics are currently prescribed, however, the heightened awareness that the White House is bringing to the problem may start to push things in the right direction. Already, Perdue, one of the country’s largest producers of poultry, announced that it will no longer use human antibiotics with 95% of its chickens.

TIME Diet/Nutrition

Artificial Sweeteners Aren’t the Answer to Obesity: Here’s Why

80356781
Artificial sweeteners may be contributing to the very health problems they were supposed to prevent, say researchers Tetra Images—Getty Images/Tetra images RF

They’re supposed to be the sweet alternative to high-calorie, diabetes-causing sugar. But the latest science shows that artificial sweeteners may actually set us up for obesity and diabetes

Aspartame, saccharin, sucralose—sugar alternatives go by many names, but share an almost irresistible promise: all the sweetness of sugar without the calories, weight gain and increased risk of diabetes that comes with uncontrolled amounts of sugar in the blood.

But studies on artificial sweeteners and weight loss—as well as research about whether sugar substitutes helped people avoid metabolic disorders like diabetes—have been mixed. And in a paper published Wednesday in Nature, Dr. Eran Elinav from the Weitzmann Institute of Science in Israel found that the sugar stand-ins actually contribute to changes in the way the body breaks down glucose. How? Fake sugars aren’t digested and therefore pass directly to the intestines, impacting the millions of invisible bacteria that live in our gut. And when he and his colleagues gave seven people who didn’t normally use artificial sweeteners the sugar substitutes for seven days, about half of the people showed higher blood glucose levels after just four days.

MORE: 5 Steps to Quitting Artificial Sweeteners

“What our comprehensive genetic profiling of the microbiome pointed to is that exposure to artificial sweeteners directly impacts the microbes,” Elinav says. “We found that the artificial sweeteners we think of as beneficial and that we use as treatment or preventive measures against obesity and its complications are contributing to the same epidemics they are aimed to prevent.”

In the intestines, gut microbes are hard at work, pulling out some nutrients from food that are helpful in stopping tumor growth, for example, and squirreling away others to store as energy for later use. But while artificial sweeteners aren’t absorbed by our own cells, they may be absorbed by our bacteria—and when that happens, things appear to go haywire.

Higher amounts of the sweetener substitutes, Elinav and his team found, can change the makeup of these bacterial communities. And that in turn can change how those bugs behave, leading to weight gain and poorer glucose breakdown. These alterations in intestinal bacteria were the same as those in a group of 400 people who reported using artificial sweeteners—and those changes were the same in mice as well.

MORE: Why Your Brain Isn’t Fooled By Sugar Stand-Ins

In the mouse studies, Elinav’s team found that the artificial sweeteners pushed one particular group of bacteria, Bacteroides, to thrive, while inhibiting growth of another, Clostridiales. Bacteroides are the microbial equivalent of hoarders, hungrily pulling energy out of food and squirreling it away as fat. The end result of a Bacteroides-heavy gut is a physically heavy gut as well. In studies by other research groups, its dominance, and the resulting drop in diversity of other microbes, is typical of obese people compared to normal weight individuals.

MORE: 7 Not-So-Sweet Lessons About Sugar

The metabolic consequences were also dramatic in both the mice and people studied. In the mouse experiments, animals who were fed the same dose of saccharin that the U.S. Food and Drug Administration considers safe for daily use showed a drop in their ability to break down glucose. When he gave those mice antibiotics, their ability to break down glucose returned to normal, suggesting that wiping out the abnormal balance of bacteria could return the animals back to a healthier state.

And to confirm that the changing microbial communities were indeed responsible for the glucose changes, he also transplanted fecal samples from the people using artificial sweeteners into mice whose own guts had been wiped clean. These mice then developed the same abnormalities in glucose breakdown that the human donors and the mice who were fed saccharin did—even though they never actually ate artificial sweeteners. Simply harboring the microbes that had been exposed to the sweeteners was enough to disturb their glucose metabolism.

MORE: Can Sugar Substitutes Make You Fat?

The good news is that as easily as the gut microbiome can shift toward an unhealthy state, it can just as easily be brought back into line with the proper balance of bacterial communities. The best way to do that isn’t clear yet, but, says Eran Segal, a co-author of the study and a professor of computer science and applied mathematics at the Weitzmann Insttitute, “We believe that the situation today at the very least needs to be re-examined. We were able to induce glucose intolerance in a few days in some individuals, so this massive, unsupervised and unregulated use [of artificial sweeteners] should at the very least be reassessed and perhaps re-examined in additional studies.”

Elinav, for one, isn’t waiting. Based on his findings, he’s stopped adding artificial sweeteners to his coffee.

 

TIME Cancer

Our Global Cancer Report Card Is Here

In its annual cancer status report, the American Association for Cancer Research highlights new tumor-fighting drugs, and the inevitable spike in cancer cases expected in coming years

The Food and Drug Administration (FDA) approved six new cancer treatments between July 2013 and July 2014, five of them representing innovative ways to target tumors more precisely with fewer side effects. Thanks to those therapies, and advances in understanding how the body’s own immune system can be co-opted into fighting cancer, patients diagnosed with any of the 200 or so forms of the disease have never been in a better position to survive it. In fact, the number of cancer survivors has increased nearly five-fold from when Congress declared a war on cancer in 1971 and 2014. But despite advances in diagnosing and treating cancer, incidence and death rates may start to rise again, say experts in a new report.

That’s in part because most cancers emerge in older age—and the population of people over-65 is expected to double by 2060. “We face a future in which the number of cancer-related deaths will increase dramatically unless new and better ways to prevent, detect, and treat cancer can be developed,” according to the 2014 American Association for Cancer Research (AACR)’s Cancer Progress Report 2014. “These trends are being mirrored globally, and the number of people dying of cancer worldwide is expected to increase from 8.2 million in 2012 to 14.6 million in 2035.”

The (AACR), which has been compiling the report every year since 2011 as an educational tool to update Congress and the public on the progress and needs in the fight against cancer, also provided a “prescription” for addressing this coming wave, and for maintaining the momentum of recent victories against the disease. Noting that research grants from the National Institutes of Health (NIH), the largest funder of basic biomedical research that has contributed to many of the new anti-cancer therapies now on the market, are $3.5 billion lower than where they should be even if the funding only kept up with the rate of inflation for biomedical equipment and personnel, the AACR urges more federal investment in cancer research.

That money, they point out, can also be directed toward training the next generation of cancer researchers, since fewer grants are turning promising young scientists away from the field. They write:

We are now at a crossroads in our country’s long struggle to prevent and cure cancer; we must choose between two paths, but there is only one viable path forward to continue transforming lives.

On the viable path we seize the momentum at this exciting time in biomedical research by committing to budget increases for the NIH and NCI so that the remarkable progress of the past can continue at a rapid pace.

To take the alternative path is simply unacceptable. This particularly dangerous path leads us to a place where federal funding for biomedical research remains stagnant, or even worse, declines, seriously jeopardizing the rate at which we are able to make progress. On this path, breakthroughs and discoveries will be slowed, meaning that delivery of the cures that patients and their loved ones desperately need is delayed.

…Our federal government can do no better than invest robustly in the NIH and NCI so that the path forward will lead us to a brighter future for the millions of people whose lives have been touched by cancer.

TIME Mental Health/Psychology

A Blood Test for Depression? Science Says It’s Possible

Blood test
Getty Images

It may even tell doctors whether patients will respond to some kinds of therapy

As with any disease, detecting depression early is critical for reducing suffering and for finding an effective course of treatment. Now, in a study released Tuesday, scientists led by Eva Redei at Northwestern Medicine say it may be possible to test for depression in the blood—and figure out which patients will benefit most from behavior-based therapy as a treatment.

While a blood test alone can only tell us so much, some 26 markers in the blood had previously been associated with depression—something Redei, a professor of psychiatry and behavioral sciences, and her team had discovered in lab animals. They also applied those findings to human subjects, and found that some of those compounds were present in teens with major depressive disorder. This prompted Redei to put their suite to the test with a sample of patients aged 23 year to 80 years recruited from a Northwestern University general medicine clinic.

In her report, published in the journal Translational Psychiatry, Redei focused on nine markers whose levels in the blood differed between people with depression those who were not depressed. Depressed people went on to receive cognitive behavioral therapy, and Redei and her colleagues followed them to see if they could find any additional markers for whether these patients responded well to the therapy or not.

“What we didn’t bargain for, but what we got, was that by looking at [patients’ blood] before they received cognitive behavioral therapy (CBT), we could identify patterns that tell us who will respond to therapy and who will not,” she says. About 60% of the patients did not experience another depressive episode during the study period’s 18 weeks. But 40% of them did, and they showed differences in three gene products that were measured in the blood.

MORE: A New Key to Understanding Depression

In addition, the team also found three markers among the original nine that remained different even among the depressed patients who benefited from CBT, and the controls. That suggests these markers could be harbingers of a person’s vulnerability to the mood disorder. In other words, they could be predisposing factors that make depression more likely in the face of stress or anxiety or trauma. Of the remaining six markers in the panel, Redei says they could be useful measures of the changing state of a patient’s depression, similar to fluctuating levels of cholesterol or blood pressure, and they could be a helpful gauge for doctors in figure out how much treatment or medication a patient might need.

MORE: Doctors Treat Depression With Brain Magnets

And these genes, she says, “are a complete and utter surprise because they are relatively unknown. Some of them are genes that are known in other areas of science or medicine but have never been associated with depression before.”

That means they could lead to a better understanding of the disease and, possibly, better treatments. “It’s very dangerous to delay treatment,” says Redei. “We don’t want anybody to suffer, so the goal is to develop a Food and Drug Administration-approved test that is very easy to administer anywhere.”

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser