TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Diet/Nutrition

Yogurt Could Lower Your Blood Pressure: New Study

The latest study links certain probiotics with better blood pressure control

Bacteria aren’t the first allies we turn to for staying healthy – there are enough strains that can cause serious illness, after all – but there’s growing evidence that certain strains of the bugs can actually be good for your health, and may even relieve symptoms of inflammatory conditions, allergies and possibly even obesity.

In the latest report on these microbial allies, researchers add one more possible benefit of probiotics – the live concoctions of bacteria contained in foods like yogurt. In an analysis of nine studies that looked at probiotic use and blood pressure, the report in the journal Hypertension found that people using probiotics tend to have lower blood pressure compared to those who didn’t eat them. The effects seemed to be stronger among those with higher blood pressure to begin with, and among those consuming multiple probiotic strains and in higher doses.

What do bacteria have to do with blood pressure? The researchers say that the micro-organisms could be helping to address hypertension in a variety of ways, from lowering cholesterol levels, which can contribute to less fatty buildup in the vessels and therefore reduce the chances of developing hypertension, to controlling blood sugar and keeping the enzymes and proteins that control blood flow and fluid volumes in check.

The results aren’t exactly a prescription for treating hypertension — at least not yet. But they raise the interesting possibility of incorporating a probiotic regimen into blood pressure management. The study authors admit, however, that more questions still need to be answered, such as which micro-organisms might be associated with the strongest effect on blood pressure, as well as which combinations of bacterial strains work best. The formulation of the probiotic may also be important, they say – in the studies they reviewed, participants consumed probiotics primarily from yogurt, but also from cheese, sour milk and supplements (liquid or capsules). Hitting the right threshold of microbes also seems to be important, and figuring out that volume is also essential before any advice about using probiotics to lower blood pressure is given.

TIME vaccines

RFK Jr. Joins the Anti-Vaccine Fringe

RFK, Jr.: Big bullhorn, bad ideas
RFK, Jr.: Big bullhorn, bad ideas Ethan Miller; 2014 Getty Images

A man who used to tell hard truths now peddles dangerous nonsense

There are lots of places to go if you want dangerous crazytalk. There are websites, blog threads, cable channels trafficking in all kinds of addled nonsense about birther conspiracies and one-world governments. And then there was Robert Kennedy, Jr., the tireless, honest climate hero long famous for fighting the very good fight.

But that was then. RFK, Jr. may still know a thing or two about global warming, but he has taken a disreputable plunge into the world of anti-science with his new and inexplicable crusade: warning people about the dangers of vaccines.

Let’s be clear: Kennedy will tell you he’s not against vaccines themselves, but rather, against thimerosal, a vaccine preservative purportedly responsible for the rise in autism in the U.S. He’s even publishing a new book—Thimerosal: Let the Science Speak—making this frightening point. The problem is: he’s wrong—utterly wrong, so wrong it’s hard even to know what the biggest piece of that wrongness is.

But let’s start with a single fact that ought to be, as the lawyers like to say, dispositive: the thimerosal ain’t there. With the exception of the flu vaccine, it was removed from or reduced to trace levels in all vaccines given to children under 6-years-old 13 years ago. You face a greater mercury risk eating seafood and fish—and even that danger is low enough that the EPA recently recommended that pregnant and nursing women increase their intake of certain kinds of fish because the nutritional benefits outweigh the theoretical dangers.

Kennedy is wrong on basic epidemiology too. Autism diagnoses have indeed risen steadily in the U.S. in recent years, but that has been happening in the same period in which thimerosal levels in vaccines plunged. When your cause goes away and your reputed effect increases, well, you really do need to review your class notes on what cause and effect mean in the first place.

Most fundamentally, Kennedy does not get chemistry. Thimerosal is an ethylmercury product. Mercury in general may be a neurotoxin, but it’s in its methylmercury form that it does its damage—and only in particular concentrations. The quantity of ethylmercury that was once in vaccines was so small that it was actually within acceptable limits for the more toxic, methyl form—but it wasn’t even in that methyl form to begin with.

Kennedy, more than most anti-vaxxers, really ought to know better. In his long career as a climate crusader he has had to answer the febrile claims from the denialists that the whole threat of global warming is a conspiracy cooked up by “grant-grubbing scientists” and liberal politicians looking to expand the role of government. Yet when it comes to vaccines, he clangs the same loony-tune bells. As long ago as 2005, he published an anti-vax article in Rolling Stone claiming to reveal how “how government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public.” And Keith Kloor, the author of a new Washington Post Magazine profile of Kennedy, reports that last year, in response to a story he wrote on the Discover magazine website labeling this kind of thinking as the nonsense that it is, Kennedy called him up and said bluntly, “I’m trying to figure out whether you are a shill for Big Pharma.”

The worst—and the least explicable—thing about Kennedy and his new cause is the company he keeps. His book is being put out by Skyhorse Publishing—an outfit that also includes the disgraced Andrew Wakefield in its stable of authors. Wakefield is the U.K. investigator whose fraudulent 1998 paper purporting to link autism to the measles-mumps-rubella vaccine set off the entire anti-vaccine wildfire. In 2010, The Lancet formally withdrew the 1998 paper and Wakefield has since been banned from practicing medicine in the U.K. And as for the company Wakefield himself keeps? The foreword to his book was written by Jenny McCarthy.

Kennedy may deeply believe the rubbish he’s peddling—but science doesn’t care about your sincerity; it cares about the facts. That doesn’t mean he’s not in a position to do real harm. Like McCarthy, he has a big soapbox and a loud bullhorn, and every parent he frightens into skipping vaccinations means one more child who is in danger.

In the Washington Post profile, Kennedy complains about the trouble he’s having getting his anti-vaccine message across. “I’m completely f***ing alone on this,” he gripes. Well, good. He deserves to be alone, and if fewer people than he hoped are listening to him, that’s a positive sign.

TIME HIV

Researchers Find New Way to Kick Out HIV From Infected Cells

Scanning electron micrograph of HIV-1
Scanning electron micrograph of HIV-1 Getty Images

The technique addresses the problem of hidden reservoirs of HIV in the body, and could herald a new way of battling the viral infection

Once HIV invades the body, it doesn’t want to leave. Every strategy that scientists have developed or are developing so far to fight the virus – from powerful anti-HIV drugs to promising vaccines that target it – suffers from the same weakness. None can ferret out every last virus in the body, and HIV has a tendency to hide out, remaining inert for years, until it flares up again to cause disease.

None, that is, until now. Kamel Khalili, director of the Comprehensive NeuroAIDS Center at Temple University School of Medicine, and his colleagues took advantage of a new gene editing technique to splice the virus out of the cells they infected – essentially returning them to their pre-infection state. The strategy relies on detecting and binding HIV-related genetic material, and therefore represents the first anti-HIV platform that could find even the dormant virus sequestered in immune cells.

MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be

Even more encouraging, they also used the system to arm healthy cells from getting infected in the first place, by building genetic blockades that bounced off HIV’s genetic material. “It’s what we call a sterilizing cure,” says Khalili.

His work was done on human cells infected with HIV in cell culture, but, he believes the results are robust enough to move into animal trials and eventually into testing the idea in human patients.

The key to the strategy is the gene editing technique known as CRISPR, a way of precisely cutting DNA at pre-specified locations. CRISPR acts as a customizable pair of molecular scissors that can be programmed to find certain sequences of DNA and then, using an enzyme, make cuts at those locations. Because HIV is a retrovirus, its genetic material comes in the form of RNA; the virus co-opts a host cell’s genetic machinery to transform that RNA into DNA, which it then inserts into the cell’s genome. HIV’s genes, which it needs to survive, then get churned out by the cell.

MORE: David Ho: The Man Who Could Beat AIDS

Khalili designed a CRISPR that recognized the beginning and end of HIV’s DNA contribution, and then watched as the enzyme snipped out HIV from the cell’s genome. “I’ve been working with HIV almost since day 1 [of the epidemic] and we have developed a number of molecules that can suppress transcription or diminish replication of the virus. But I have never seen this level or eradication,” he says. “When you remove the viral genes from the chromosomes, basically you convert the cells to their pre-infection state.”

The advantage of the system lies in the fact that CRISPR can recognize viral genes wherever they are – in infected cells that are actively dividing, and in infected cells in which the virus is dormant. Current drug-based strategies can only target cells that are actively dividing and releasing more HIV, which is why they often lead to periods of undetectable virus but then cause levels of HIV to rise again. That’s the case with the Mississippi baby, who was born HIV positive and given powerful anti-HIV drugs hours after birth and appeared to be functionally cured of HIV when the virus couldn’t be detected for nearly four years, but then returned.

MORE: Rethinking HIV: After Five Years of Debate, a New Push for Prevention

Khalili admits that more work needs to be done to validate the strategy, and ensure that it’s safe. But it’s the start, he says, of a potential strategy for eradicating the virus from infected individuals. That may involve excising the virus as well as bombarding it with anti-HIV drugs. “We can get into cells, eradicate the viral genome, and that’s it,” he says.

TIME Health Care

Johns Hopkins to Pay $190 Million to Victims of Secretly Recorded Exams

Johns Hopkins Hospital
A sign stands in front of part of the Johns Hopkins Hospital complex, Tuesday, July 8, 2014, in Baltimore. Patrick Semansky—AP

A male gynecologist secretly filmed and took pictures during exams with female patients

Johns Hopkins Hospital announced on Monday that it reached a $190 million settlement with patients whose exams were secretly recorded by a gynecologist.

The class-action lawsuit involved more than 8,000 former patients of Dr. Nikita Levy, the Associated Press reports, and the deal marks one of the largest involving sexual misconduct by a doctor. Most of the discovered videos and photographs—about 1,200 videos and 140 photos—did not include the women’s faces and were taken with a pen-like camera he wore around his neck.

The case never led to criminal charges but essentially argued that Johns Hopkins should have been aware of what the doctor was doing. Levy committed suicide 10 days after he was fired in February 2013, which occurred after an employee came forward with suspicions.

Johns Hopkins released a statement in October on the discovery of Levy’s “misconduct and breach of trust,” writing: “We have redoubled our efforts to ensure that all of us in the Johns Hopkins community understand our responsibility, and we want to encourage you to speak up if you have any concerns about patient care or privacy.”

In a statement sent to reporters, Jonathan Schochor, the lawsuit’s lead attorney, said: “When learning of Dr. Levy’s behavior, our clients were extremely distraught. They felt a great breach of faith and trust. They felt betrayed. Now, with this proposed settlement, we can begin the process of healing our community.”

The settlement still needs final approval by a judge, the AP reports.

“We assure you that one individual does not define Johns Hopkins,” the hospital system said on Monday, acknowledging the settlement. “Johns Hopkins is defined by the tens of thousands of employees who come to work determined to provide world-class care for our patients and their families.”

TIME Education

School Administrators: Kids Like Healthy Lunches Just Fine

150968856
Female student carrying tray in cafeteria Tetra Images—Getty Images/Brand X

According to a new survey published in the Childhood Obesity journal

As the battle rages on over whether or not to scrap healthier options in public school lunch, a new survey suggests students actually like the nutritional meals they’re being offered. Well, at least they like it enough to keep from complaining to school administrators about it.

Last school year, administrators reported students started off complaining about the healthier take on lunch, after the USDA introduced new standards in 2012 that called for a reduction in sugar, sodium and fat in meals and the addition of more whole grains, vegetables, and fruit in an effort to confront childhood obesity.

But most had come around by the spring, they reported in a new study backed by the Robert Wood Johnson Foundation. Now, around 70% of elementary school students “generally like the new lunch,” they said. Middle and high school administrators reported similar reactions, with 70% and 63% of students “generally” liking the new lunches, respectively.

Schools also report few drop-offs in school lunch participation with the advent of the new standards. About 64.6% of elementary schools said “about the same” number of students purchased school lunches last school year, compared to the year before.

“The updated meals standards are resulting in healthier meals for tens of millions of kids,” said Lindsey Turner, lead author of the first study, and co-investigator for Bridging the Gap, a research program of the Robert Wood Johnson Foundation (RWJF), which funded the study in a statement. “Our studies show that kids are okay with these changes, and that there have not been widespread challenges with kids not buying or eating the meals.”

Yet, according to the new survey to be published in an upcoming issue of the Childhood Obesity journal, high school students and students in rural schools have been more reluctant to accept the changes. About 25% of middle and high school administrators reported noticing “a little more” plate waste during the 2012-2013 school year, while 16% of middle schools and 20% of high schools reported noticing “much more” waste.

Administrators at rural schools also reported more plate waste and more complaints than their urban counterparts, which is troubling given the higher rates of obesity among youth in rural areas. But among poor urban youth, the researchers found higher rates of consumption and more meal purchases—suggesting those kids opting out of the school lunch program are those who can afford to eat elsewhere.

“It is possible that widespread implementation of national policy has been effective for improving the diets of socioeconomically disadvantaged children,” said the study’s authors, “but more research is needed to understand the effect of changes in the meal standards on children’s participation and dietary intake.”

There has been much debate over the Department of Agriculture’s updated school nutrition standards this year. In fact, Monday’s survey results stand in contrast to a recent USDA report that showed about 1 million fewer students chose to eat school meals every day during the 2012-2013 school year. The School Nutrition Association, a long time supporter of healthy options for kids, rolled back some of its support earlier this year due to the burden the standards place on already cash-strapped schools.

In May, House Republicans ok’d a spending bill that would allow schools to opt out of following the healthy school rules, which pump up the amount of fruit, vegetables, and whole grains served to kids at school while reducing fat, sugar, and sodium. But champions of the standards, including First Lady Michelle Obama, argue rolling back the standards would be a bad choice for kids.

In a statement Monday, the School Nutrition Association said the survey’s “perceptions about school meals do not reflect reality.”

“More kids aren’t buying lunches,” Diane Pratt-Heavner, spokesperson for the School Nutrition Association, tells TIME.

TIME Diet/Nutrition

Eat Umami, Eat Less

Calories count when it comes to weight, but taste may play a role as well.

If you’re feeling unsatisfied after a meal, perhaps wasn’t flavorful enough. A new study suggests that the taste umami may actually make you feel more full and satisfied.

Umami, a hard-to-describe flavor that tilts toward the savory, is considered the “fifth taste” after salty, sweet, sour and bitter. Long used in Japanese cooking, umami is actually glutamate, once it’s broken down by cooking a steak, for example, or by fermenting things like cheese and soy. For a quick dash of umami, cooks have turned to monosodium glutamate (MSG), a flavor enhancer that’s added to soups and other foods. Now a new study published in The American Journal of Clinical Nutrition, suggests that MSG can make food more appetizing and therefore help diners feel more full.

The researchers asked 27 participants to eat the same breakfast, then some ate a high-protein soup with an MSG-enzyme combination while other had soup without the pairing. Everyone then sat down for an identical lunch, and the scientists tracked how much the volunteers ate as well as asked them questions about their appetite and how full they felt. The diners who ate the MSG-laced soup consumed less of their lunch, but still say they felt satisfied, suggesting that umami may have a role in regulating eating.

It’s not the first taste linked to appetite — peppers and spicy foods, for example, have been associated with eating less. It’s not exactly clear how the flavors affect appetite — they may work in different ways — but the growing research suggests that how much you eat may be affected by which taste buds the food activates.

TIME Stress

Burnout in the Hospital: Why Doctors Are Set Up for Stress

Every job can lead to burnout, but what happens when it strikes doctors, who make decisions that can affect their patients' lives?

Some experts call physician burn out “inevitable,” given the high-pressure environment in which they must make potentially life-saving, and almost always life-altering, choices on a constant basis. Research shows that up to 40% of U.S. doctors experience emotional, physical, and psychological burnout from their jobs, and the consequences are no different for them than they are for people in other occupations — substance abuse and cutting corners.

In the premiere issue of the journal Burnout Research, which is dedicated to research on the topic, Anthony Montgomery, an associate professor in the Psychology of Work and Organizations in the University of Macedonia in Greece, focused on physician burnout, and argues that the way doctors are trained may set them up for a career of frustrations and high-stress situations. And the consequences may be hurting the care they provide patients.

He says that while doctors interact with people on a daily basis, their training and their worth as physicians are focused almost entirely on their technical capabilities, leaving them with few tools for understanding and navigating social interactions and for collaborating as part of a larger team or organization.

Montgomery argues that most medical students are chosen because of their high test scores, so medical school becomes like an extension of school. They then become residents, thrown into a more social environment in which they are expected to interact with patients, hospital staff and colleagues in ways they may not have expected to or been prepared to do. It’s assumed they have the leadership skills and the proper emotional capacity to guide patients through extremely stressful and often traumatic experiences, but not having the tools to manage these situations can be stressful on the doctors themselves. While burnout among physicians is widespread, some studies have shown surgeons and OBGYNs can be at a particularly high risk.

“The irony is that doctors are the one group of people we don’t want to be stressed, yet we are increasing the possibility for them to make mistakes,” says Montgomery. “Doctors understand that their job is to be the best doctor they can, but [they do] not necessarily [understand] their part in helping the hospital as a whole better serve the community.” In his practice, for example, Montgomery says that his colleagues admitted to learning skills like communication and teamwork on the job, after they left medical school.

And that’s not just a problem for the medical community. The more doctors feel stressed about their jobs, the more they feel burned out and defeated by the health care system, leading to less motivation to improve conditions, both for themselves and for patients. A 2012 study published in Archives of Internal Medicine reported that nearly 1 in 2 U.S. physicians report at least one symptom of burnout, like losing enthusiasm for their work, or growing cynical. Forty percent of doctors reported being unsatisfied with their work-life balance and that they did not have time to devote to their families or their personal lives. And in a 2013 study published in JAMA, the consequences of that burnout started to emerge — only 36% of 2,556 surveyed physicians believed doctors had a major responsibility in reducing health care costs, despite the fact that they prescribe the drugs, tests and procedures that can escalate costs. Other studies also link burnout to poorer quality care and increased rates of medical errors.

What can be done to alleviate some of the pressure on physicians? Montgomery cites revisiting the way doctors are educated in order to arm them with stronger social and leadership skills, as well as some untraditional strategies, including teaching mindfulness. Improving the doctor-patient relationship may also help, so physicians and patients collaborate in their care rather than perpetuate a hierarchical system which neither doctor nor patient finds satisfying. He writes: “The uncomfortable truth is that we may need to reimagine healthcare in a way that views some errors as unavoidable, demystifies the physicians as superheroes, engages real patient participation and steers healthcare professionals away from cultures of self-preservation.” In other words, making health care more satisfying for physicians and patients may be a group effort, and that’s something that doctors aren’t quite used to yet.

 

TIME

Lawyer: Pelvic Exam Pics Cost Hopkins $190 Million

(BALTIMORE) — Johns Hopkins Hospital has agreed to a $190 million settlement with more than 8,000 patients of a gynecologist who secretly photographed and videotaped women in the examining room with a pen-like camera he wore around his neck, lawyers said Monday.

Dr. Nikita Levy was fired in February 2013, days after an employee alerted hospital authorities about her suspicions. Ten days later, Levy committed suicide.

The agreement, announced Monday, is one of the largest settlements on record in the U.S. involving sexual misconduct by a physician.

It all but closes a case that never produced criminal charges but threatened the reputation of one of the world’s leading medical institutions and, according to lawyers, traumatized thousands of women, even though their faces were not visible in the images and it could not be established with certainty which patients were recorded or how many.

“All of these women were brutalized by this,” said the women’s lead attorney, Jonathan Schochor. “Some of these women needed counseling, they were sleepless, they were dysfunctional in the workplace, they were dysfunctional at home, they were dysfunctional with their mates. This breach of trust, this betrayal — this is how they felt.”

Johns Hopkins declined to comment to The Associated Press ahead of a planned announcement later Monday.

Baltimore police were called in by Johns Hopkins just before Levy’s firing. They and federal investigators discovered roughly 1,200 videos and 140 images in a search of his home but said there was no evidence he shared the material with others.

A class-action lawsuit on behalf of more than 8,000 of his patients who contacted lawyers was brought against Johns Hopkins last fall, alleging the hospital should have known what he was up to.

Some women told of being inappropriately touched and verbally abused by Levy, according to Schochor. In some cases, women said they were regularly summoned to Levy’s office for unnecessary pelvic exams.

Myra James, 67, had been going to him for annual exams for 20 years. Since his misconduct became public, she hasn’t been to a gynecologist once.

“I can’t bring myself to go back,” James said. “You’re lying there, exposed. It’s violating and it’s horrible, and my trust is gone. Period.”

The AP normally does not identify possible victims of sex crimes, but James agreed to the use of her name.

The settlement, involving eight law firms, is subject to final approval by a judge. A forensic psychologist and a post-traumatic stress specialist interviewed the plaintiffs and placed each woman into a category based on trauma level. That will determine how much money each one will receive.

Hopkins issued a statement in October saying it was working to settle the claims in a way that “helps our patients and colleagues move forward.”

Levy, 54, graduated from Cornell University and had been employed at Hopkins since 1988. When the allegations came to light, he was working at Hopkins East Baltimore Medical Center, a community practice affiliated with Johns Hopkins Hospital. During his 25-year tenure, he saw roughly 12,600 patients.

His suicide — by wrapping his head in a plastic bag with a hose connected to a helium tank — frustrated everyone who wanted to know his motives and see him face justice.

Schochor said there is no way to identify which patients were recorded without having them “sit around a table and try to identify sexual organs without pictures of faces,” something the lawyer said would be impossible and could cause the women more distress.

Hopkins sent out letters to his entire patient list last year apologizing to the women and urging them to seek care with other Hopkins specialists.

But hundreds were so traumatized that they “dropped out of the medical system,” and some even stopped sending their children to doctors, Schochor said.

James said her dealings with Levy were always unsettling. She said she found it strange that he conducted examinations without a nurse present.

“He was cold, and I was kind of scared of him. His bedside manner — he didn’t have any,” she said. “But all my doctors were at Hopkins. I’ve had two surgeries there, my primary doctor is there. I was used to going there for everything.”

TIME Diet/Nutrition

3 Ways to Kick Your White-Bread Habit

891893-001
There are many strategies for avoiding white bread Angela Wyant—Getty Images

Some of my clients wouldn’t touch white bread, rice, or pasta with a 10-foot pole, while others just can’t seem to make the switch to whole-grain alternatives. For the latter group, it’s either because they’re so accustomed to the flavor or texture of refined grains, or because they’ve had a bad experience with healthier options.

For example, one of my pro athlete clients recently told me that whole-grain pasta tastes like sticky cardboard mixed with glue, a pretty vivid and unappetizing description! But it turns out, the pasta he tried was way overcooked and unseasoned. If, like him, you’re reluctant to try again, I encourage you to give it another go, because racking up more nutrients isn’t the only benefit.

Health.com:16 Whole Grains You Need to Try

A recent Spanish study that tracked the eating habits and weights of more than 9,000 people found that those who ate only white bread and downed two or more portions a day were 40% more likely to become overweight or obese over a five-year period, compared to those who ate less than one portion of white bread a week. While the study didn’t include rice or pasta, other research backs the notion that consuming whole-grain versions curbs obesity risk, and protects against a number of chronic diseases, including type 2 diabetes, heart disease, stroke, and certain cancers.

Try these three tricks to reap the benefits of whole grains without feeling like you’re choking down cardboard. You may never crave the pale stuff again!

Health.com:The 20 Healthiest Breakfast Foods

Spruce up with spreads

A hearty whole-grain bread can overpower the flavor of sandwich fillings. To balance it out, slather on a plant-based spread or two, including hummus, olive tapenade, pesto (like sun-dried tomato, roasted red pepper, artichoke, or eggplant), tahini, ripe avocado, or guacamole. In addition to being delicious, these spreads add heart-healthy fat and boost your antioxidant intake. To prevent carb overkill (and an overly grainy texture), opt for an open-faced sandwich, or use crisp Romaine leaves as the top layer so you can still pick it up with both hands and bite in.

Become season-savvy

Nearly everyone who’s told me they don’t like brown rice or other cooked whole grains like quinoa tried them plain—and a little seasoning can make a huge difference. One of the simplest ways to add both flavor and moisture is to quickly sauté cooked grains in organic low sodium vegetable broth along with herbs and spices. There are dozen of options, but some of my favorite combos include: minced garlic with fresh grated ginger and crushed red pepper; garlic with fresh cilantro and fresh squeezed lime juice; or garlic with fresh squeezed lemon juice, black pepper, and Italian herb seasoning. In addition to serving them hot, seasoned whole grains can also be chilled. Either way, try tossing them with chopped or shredded veggies, lean protein, and a good-for-you fat, like extra virgin olive oil, chopped nuts, or minced avocado.

Health.com:16 Ways to Lose Weight Fast

Think al dente

These days there are a wide variety of whole-grain pasta options, including whole wheat, or gluten-free choices, like brown rice pasta, quinoa pasta, and noodles made from black beans and buckwheat. But when it’s overcooked, any pasta can lose its appeal. Whole-grain versions do take a little bit longer to cook than white pasta, but the difference is generally only a few minutes, much less than most people think. So start checking it right away, and turn off the heat when the pasta is still firm to best preserve the texture.

Health.com:31 Superfood Secrets for a Long and Healthy Life

Like bread and rice, whole grain or white pasta alternatives taste best when paired with robust sauces, so let your culinary creativity run wild. Try healthy add-ins with bold flavors like Kalamata olives, capers, wild mushrooms, and caramelized onions, or stir in a little balsamic vinegar or harissa seasoning. Or forgo pasta sauce in favor of a dollop of one of the spreads I mentioned above, like sun-dried tomato or eggplant pesto. Hot or chilled, the right combination may just win you over!

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor. Frequently seen on national TV, she privately counsels clients in New York, Los Angeles, and long distance. She’s also the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics. Her latest New York Times best seller is S.A.S.S! Yourself Slim: Conquer Cravings, Drop Pounds and Lose Inches.

This article originally appeared on Health.com.

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