TIME vaccines

How to Change an Anti-Vaxxer’s Mind

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

Jeffrey Kluger is Editor at Large for TIME.

It's not easy, but a new study suggests one way to help persuade parents to vaccinate their children

Let’s take a moment and praise anti-vaccine parents. Really. They’re wrong on the science, wrong on the politics, and deeply, morally wrong to deny their own children a simple disease preventive that they themselves likely enjoyed growing up. But like all parents everywhere, they’re acting on a simple, powerful impulse: to keep their children healthy.

That’s a very noble goal, but it’s also one of the things that makes it so bloody hard to change their minds on the topic of vaccines. Public service campaigns don’t work; nor do one-on-one explanations of why the rumors about a vaccine-autism link are wrong. In some cases, there is even a backfire effect: the greater the effort expended to persuade the anti-vaxxers, the more convinced they become that they’re right.

So it’s extremely good news that researchers at the University of Illinois Urbana-Champaign may at last have come up with a way to cut through the misinformation and get the truth across: Don’t just tell parents to vaccinate their children, show them what happens if they don’t.

In a study published in the Proceedings of the National Academy of Sciences, a team led by graduate student Zachary Horne recruited a sample group of 315 people—both parents and non-parents—and first conducted a simple survey designed to measure their pre-existing attitudes to vaccines. The subjects were asked to respond on a six-point scale, from “strongly agree” to “strongly disagree,” to five statements that included, “The risks of side effects outweighs any potential benefits of vaccines” and “I plan to vaccinate my children.”

All of the subjects were then divided into three groups: One group was given material to read about the latest research showing that autism and vaccines are in no way related. The second group was given a paragraph to read written in the voice of a mother describing what it was like when her child contracted measles; three pictures of children with measles, mumps and rubella; and written warnings about the importance of vaccinating children. The third group, serving as a control, read material on an unrelated science topic.

When the three groups’ attitudes to vaccines were tested again, the results were striking. Both the control and the so-called “autism correction” group showed a slight uptick in their approval of vaccines, but in neither case were the numbers terribly significant. The group that had learned about the wages of vaccine denialism changed markedly, however, with increased approval rates five times larger than those in the autism correction group and six times larger than in the control group.

“Rather than attempting to dispel myths about the dangers of vaccinations,” the researchers wrote, “we recommend that the very real dangers posed by serious diseases like measles, mumps and rubella be emphasized.”

As TIME reported in the Oct. 6, 2014 issue, this is precisely the approach that worked during the mumps outbreak in Columbus, Ohio last year. College students were nonchalant about getting vaccinated, but when they learned that the disease can lead to sterility in both men and women, they were a lot more inclined to step up for their shots. “I was pretty freaked out,” one Ohio State University student said. “I didn’t know mumps could lead to any of that.”

The power of the show-don’t-tell approach is nothing new. It’s the reason behind the anti-tobacco shock ads showing people dying of lung cancer, as well as the surgery fund-raising ads showing photos of babies with cleft lips. The trick in all of these cases is getting people to act fast. If too much time elapses between image and potential action, the power of the message is lost.

For that reason, Horne and his co-authors suggest that future research should look at the effectiveness of including the kind of counseling that was used in their study during routine well-baby visits, when vaccinating the child on the spot is an option. After all, the effect of scaring a parent straight may be temporary, but the damage done to a child who contracts a vaccine-preventable disease can be for life.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

Men Are the Forgotten Grievers in Miscarriage

Sarah Elizabeth Richards is the author of Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.

The lesson from Mark Zuckerberg's decision to open up

Priscilla Chan and Mark Zuckerberg’s revelation last week that they had suffered through three miscarriages before she became pregnant earned widespread praise for their willingness to discuss an often hushed topic. Even more astonishing: It was a man sharing his emotions. “It’s a lonely experience,” Zuckerberg wrote in a Facebook post. “You struggle on your own.”

The medical community increasingly recognizes the emotional toll of the 15% to 20% of pregnancies that end in miscarriage, and celebrities from Beyonce to Nicole Kidman and Mariah Carey have publicly discussed their private grief with pregnancy loss. Yet this new culture of openness has mostly focused on women’s suffering.

“Men are the forgotten grievers,” explains Sharon Covington, director of psychological support services at Shady Grove Fertility Center in Washington, D.C. “Women usually get the attention. It’s often a medical crisis, if she needs a D & C.,” she says, referring to the dilation and curettage procedure that might be required to remove tissue from the uterus. “Also, women are more likely to show their emotions.” She says she often sees patients who embrace the stereotypical gender roles often exemplified at traditional Irish wakes. “Women grieve and wale. Men stand at the distance and drink their whiskey,” she says.

Research shows that men do process the emotional trauma of pregnancy loss differently. A handful of studies have found that they also suffer from anxiety and depression, albeit at less consuming levels and for shorter periods of time. One British study of 323 men, however, found although they displayed less “active grief” than their female partners, they were more vulnerable to feelings of despair and difficulty in coping eight weeks following the loss. (The grief level was higher the longer their partners’ pregnancy and also higher if they had seen an ultrasound scan.)

“Men don’t grieve in that they don’t feel the failure of their body. Women’s grief is more intense and self-blaming,” explains Irving Leon, a psychologist who specializes in reproductive loss and an adjunct associate professor of obstetrics and gynecology at the University of Michigan. “Men aren’t as oriented to express the loss. They’re afraid they if they show hurt or sadness, it will bring the wife down.”

In one survey of 40 men, 59% said they had a deepened awareness of the fragility of life, 45% mourned the loss of their family’s hopes and dreams, 50% reported they did not share feelings with their partner, and 40% reported a strong sense of vulnerability and powerlessness to help their wife.

Yet it’s critical men get help, too. Not only is their own mental health at risk, their isolation can hurt their partners’ well-being and destroy their relationships. One study showed that some men who had more difficulty coping following a miscarriage were vulnerable to a “delayed grief response” two years later. Then there’s this link: Six months after a miscarriage, the women who were most depressed had partners who were least likely to talk about the loss. Not surprisingly, women who perceived their partners as caring and willing to share their feelings about miscarriage, were closer, and had more sex a year after the trauma.

Over the years, Covington has tried offering men’s support groups, but too few men showed up to keep them going. She’s had more success with co-ed groups for pregnancy loss where men feel more comfortable attending with their partners. During her group and private sessions, Covington stresses the importance of creating mementos or rituals to acknowledge the child they never got to know. “It’s a different kind of mourning,” Covington explains. “You’re not grieving memories. You’re grieving the hopes and dreams you had for this baby. You have to make the loss real to you and find a way to express it.” She encourages patients to write farewell letters and then bury or burn them in a fireplace or tear them up into little pieces and throw them into a stream.

When Ryan McKeen, 35, and his wife were devastated from two miscarriages — one at six weeks and another at 12 weeks — following infertility treatment six years ago, a nurse recommend they see a counselor. “Guys don’t talk about it. I was trying to be there for my wife, but I realized I had these terrible feelings of loss, too,” says McKeen, a lawyer from Connecticut. “When you lose a dog, people give you card. Nobody gives you a miscarriage card. There’s not a birth or death certificate.”

When men are more willing to share their stories, the public is hungry to hear them. Marcus Brotherton’s 2013 blog post “How a Man Handles A Miscarriage” generated nearly 6,500 Facebook shares and 290 comments.

And Zuckerberg’s post has received nearly 1.7 million “likes” so far. “In today’s open and connected world, discussing these issues doesn’t distance us; it brings us together,” he wrote in his Facebook post. “It creates understanding and tolerance, and it gives us hope.”

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Diet/Nutrition

These Are the Worst Pizzas in America

And 8 healthier indulgences to eat instead

Melted cheese recently melted the Internet, when Pizza Hut introduced their latest artery-clogging frankenfood, the 15″ Hot Dog Bites pie—a large, one-topping pizza with pigs-in-a-blanket backed into the crust. “I tried it and survived,” wrote one taste-tester online. This, about a food our Italian ancestors imagined would be a low-cal appetizer.

Unfortunately, Pizza Hut isn’t alone in offering pies that better resemble manhole covers than Neapolitan delicacies. At most popular restaurants and in frozen food aisles, thin, healthy crusts have gotten thicker, more bloated with cheap carb calories. Toppings have gotten gimmicky, so healthy mozzarella and tomato sauces are sometimes replaced with things like burger meat, ziti or chicken fingers. And serving sizes—especially for “individual” pizzas—have taken these pies to a new level of caloric callousness.

How bad is it? The editors of Eat This, Not That! magazine researched every pie in America and determined the absolute worst for your health and waistline. Indulge once in a while with our relatively healthier choices.

  • 1. Worst Pizza Slice

    Sbarro Stuffed Sausage and Pepperoni Pizza (1 slice)
    810 calories, 40 g fat (15 g saturated fat), 2,180 mg sodium, 73 g carbohydrate, 36 g protein
    That’s the Fat Equivalent of: 10 slices of pan-fried bacon!

    The architecture of this thing makes it less like a slice of pizza and more like a pizza inspired Chipotle Burrito. It relies on an oversize shell of oily bread to hold together a gooey wad of cheese, sausage and pepperoni. The net result is a pizza pocket with two-thirds of your day’s fat and more than a day’s worth of sodium. And the traditional pizza slices aren’t much better; few fall below 600 calories. If you want to do well at Sbarro, think thin crust with nothing but produce on top.

    Eat This Instead!
    Sbarro New York Style Fresh Tomato Pizza (1 slice)
    410 calories, 14 g fat (8 g saturated fat), 790 mg sodium, 53 g carbohydrates, 16 g protein

  • 2. Worst New Pizza

    Pizza Hut Hot Dog Bites Pizza
    Estimated per slice: 460 calories, 30 g fat, 9.9 g saturated fat, 32.7 g carbohydrates
    That’s the Fat Equivalent of: 7.5 Taco Bell Soft Fresco Steak Tacos!

    We’ve seen Pizza Hut do some kooky things in the past to try to woo new fans—remember the Crazy Cheesy Crust Pizza, with 16 crust pockets of five totally different cheeses? Their latest monster mashup is Hot Dog Bites Pizza—a cheesy, pepperoni pizza surrounded by pigs in a blanket instead of the standard crust. Combining two fattening, calorie-dense, all-American foods is a lose-lose situation (though you won’t lose weight)—there’s a whopping 3,680 calories in a typical, 8-slice pie, to be exact. Oh, and it’s served with French’s mustard—for dipping all those hot dogs, of course. Yum?

    Eat This Instead!
    Pizza Hut Skinny Beach Pizza, 1 slice, 14” large skinny slice
    400 calories, 12 g fat (6 g saturated), 880 mg sodium, 56 g carbohydrates.

  • 3. Worst Frozen Pizza

    Red Baron Thin & Crispy Pepperoni Pizza (½ pie)
    400 calories, 19 g fat (9 g saturated), 1,020 mg sodium, 41 g carbohydrates
    That’s the Saturated Fat Equivalent of: 16 Burger King Chicken Tenders!

    “Thin & crispy” sounds healthy, but the Baron’s pie gives Burger King Chicken Tenders a run for their money in saturated fat content. If you’re in the frozen aisle, choose Newman’s Own Thin & Crispy Uncured Pepperoni, Kashi Stone-Fired Thin Crust Pizza Mushroom Trio & Spinach instead, or—if you absolutely must-have a nostalgic guilty pleasure: Bagel Bites. They’re not the perfect snack, but still decent for a non-diet pizza product.

    Eat This Instead!
    Bagel Bites (4 pieces)
    200 calories, 6 g fat (2.5 saturated), 340 mg sodium, 28 g carbohydrates

  • 4. Worst Pizza Wannabe

    Romano’s Macaroni Grill Smashed Meatball Fatbread
    1,420 calories, 59 g fat, 28 g saturated fat, 2,970 sodium, 149 g carbohydrates
    That’s the Calorie Equivalent of: Almost 17 Eggo Confetti Waffles!

    That is not a typo: Romano’s loudly advertises their “fatbread”—baked dough smothered with cheese and toppings—as being “fat on crust, fat on toppings and fat on flavor” but they should have added “fat on you.” Consuming more than half of your daily calories in one sitting is just asking for a 3 P.M. desktop snooze and a fatter tummy. Skip them and choose a simpler pasta instead. (But beware: Ravioli alla Vodka and the Penne Arrabbiata are 2 of only 4 lunchtime pastas with fewer than 1,000 calories.)

    Eat This Instead!
    Ravioli alla Vodka
    660 calories, 37 g fat, 20 g saturated fat, 1,440 sodium, 50 g carbohydrates.

  • 5. Worst Pizza for Kids

    CiCi’s Pizza Buffet Mac & Cheese (two 12” Buffet Pizza Slices)
    380 calories, 9 g fat (4 g saturated fat), 880 mg sodium, 60 g carbohydrates
    That’s the Carb Equivalent of: Shotgunning more than 4 slices of Wonder bread!

    Macaroni and cheese pizza? While it might seem like the best idea ever to kids the world over, this cute concept is potentially disastrous for your health—and your children’s. Why top an already carbohydrate-heavy dish with more carbs, not to mention fat? While the calorie count doesn’t register as high as most problematic pies on this list, that’s only because the slices are tiny; believe us, in CiCi’s all-you-can-eat environment, the damage can add up quickly. But if you bring one of their pizzas home, celebrate their smaller slices as built-in portion control—and go with flatbread. The kids will love the crunch.

    Eat This Instead!
    Cheese Flatbread (2 slices)
    200 calories, 9 g fat (5 g saturated fat), 380 mg sodium, 24 g carbohydrates

  • 6. Worst Seafood Pizza

    Red Lobster Lobster Pizza
    680 calories, 31 g fat (12 g saturated fat), 1,740 mg sodium, 66 g carbohydrates
    That’s the Fat Equivalent of: 442 large shrimp!

    Fare from the sea is typically a healthy way to go, but sprinkle it over a bed of starchy dough and fatty cheese and you have a different story altogether. Billed as a starter, this Lobster Pizza is the only pizza on Red Lobster’s menu—luckily it shares space with one of the world’s greatest appetizers: shrimp cocktail.

    Eat This Instead!
    Chilled Jumbo Shrimp Cocktail
    120 calories, 1 g fat, 590 mg sodium, 9 g carbohydrates

  • 7. Worst Mashup Pizza

    Papa John’s Fritos Chili Pizza (2 slices)
    720 calories, 30 g fat (12 g saturated), 1,400 mg sodium
    That’s the Sodium Equivalent of: Dumping 5 salt packets into your mouth!

    Papa John’s seasonal concoction of pizza, beef chili and yes, Fritos is an insult to almost every cuisine known to man. By our estimates, a whole pie would come salted up with nearly 6,000 mg of sodium! A better defense is a good offense, so start your meal off here with a few pieces of belly-filling protein in the form of wings or chicken strips. Consider it insurance against scarfing too many slices later on.

    Eat This Instead!
    The Works Original Crust Pizza (1 slice, large pie) and Chickenstrips (3) with Cheese Dipping Sauce
    400 calories, 26 g fat (8.5 saturated fat), 1,060 sodium

  • 8. Worst Pizza in America

    Uno Chicago Grill Chicago Classic Deep Dish Individual Pizza
    2,300 calories, 164 g fat (53 g saturated, 1 g trans fat), 4,910 mg sodium, 119 g carbohydrates
    That’s the Sodium Equivalent of: 27 small bags of Lays Potato Chips!

    The problem with deep dish pizza (which Uno’s knows a thing or two about since they invented it back in 1943) is not just the extra empty calories and carbs from the crust, it’s that the thick doughy base provides the structural integrity to house extra heaps of cheese, sauce, and greasy toppings. The result is an individual pizza with more calories than you should eat in a day. Oh, did we mention it has nearly 3 days’ worth of saturated fat, too? The key to (relative) success at Uno’s lies in their flatbread pies—and share them!

    Eat This Instead!
    Cheese and Tomato Flatbread Pizza (1⁄2 pizza)
    490 calories, 23.5 g fat (11 g saturated), 1,290 mg sodium, 48 g carbohydrates

    This article originally appeared on Eat This, Not That!

    More from Eat This, Not That!

TIME Cancer

Users of Jessica Alba’s Honest Company Sunscreen Are Posting Photos of Epic Sunburns

An investigation by NBC5 in Chicago found that the company reduced the zinc oxide levels in its sunscreen to 9.3%, when the standard is between 18 and 25%

Eco-friendly Honest Company’s sunscreen may be “naturally derived,” “unscented” and “non-toxic,” according to the company’s website, but now some users on social media are claiming that it doesn’t work.

The sunscreen, promoted by sometime-movie-star Jessica Alba’s wildly successful baby product company as “providing the best broad spectrum protection for your family,” is getting bad reviews by users online, many of whom are posting painful-looking sunburn photos they say they took after using the product.

In a statement to the Today Show, the Honest Company stressed that the sunscreen is tested by an independent third party with positive results and that “the number of complaints received on our own website about our Sunscreen Lotion constitute less than one half of one percent of all units actually sold at Honest.com. We stand behind the safety and efficacy of this product.”

A country-wide investigation by NBC5 in Chicago found that the sunscreen’s formula was changed at some point, reducing to 9.3% non-nano zinc oxide from 20%. (The majority of zinc oxide sunscreens list their active ingredients at 18 to 25%). Still, the company says it added other components to make up for the difference in zinc.

“The Honest Company has been transparent about the amount of zinc since the new formula came out in early 2015 as seen on the website and the new formula’s packaging,” the company told Today.

[Today]

Read next: You Asked: Is Sunscreen Safe —and Do I Really Need It Daily?

 

TIME health

Vaccinations Have Always Been Controversial in America

vaccination
Getty Images

Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

While creating the polio vaccine, Jonas Salk had to deal with critics like Walter Winchell, who warned, "It may be a killer"

In 1952, Americans suffered the worst polio epidemic in our nation’s history. As in prior outbreaks, the disease spread during the summer, mainly attacking children who had been exposed to contaminated water at public pools or contaminated objects in other communal places. The poliovirus entered the body through the mouth and multiplied in the gastrointestinal tract. Symptoms started innocently enough—a sore throat, a runny nose. As the virus moved throughout its victims’ bloodstreams, the pains soon began—electric shocks darting through the neck to legs, muscle spasms. Within a day or two, paralysis set in. If the virus made it to the nervous system in the base of the brain, death came quickly. By the time the outbreak’s end, 58,000 people had been stricken. More than a third were paralyzed, many of whom spent the rest of their lives in a wheelchair or bed.

Most Americans today have no concept of the terror generated by polio throughout the first half of the 20th century. During epidemics, newspapers and magazines displayed adorable children struggling to walk in braces or entombed in iron lungs, but the disease mostly fell off the national radar after it was eliminated from the country in 1979. In the past few years, however, polio has begun creeping back into headlines, for two opposite reasons. On the one hand, thanks to the Global Polio Eradication Initiative, the world is closer than ever to wiping out the virus completely; widespread vaccination efforts reduced the number of cases to 414 in 2014, mostly in Pakistan and Afghanistan. On the other hand, because of recent anti-vaccination trends, it’s not unreasonable to worry that a resurgence of polio might afflict Americans again.

The person responsible for easing our minds over the past half century was Jonas Salk, a physician-scientist who was born in a New York tenement and driven by a passion to aid mankind. During the 1952 outbreak, with funds from the March of Dimes, he rushed to develop the earliest vaccine for polio that used a killed, or “inactivated,” form of the virus. In that, he met resistance from more-senior scientists who believed that only a vaccine made from a live virus could provide lifelong protection.

The public was desperate for a vaccine, yet Salk was afraid these scientists would try to derail his efforts. Objections from one even prompted the famed newscaster Walter Winchell to warn his radio audience not to take the vaccine, because “it may be a killer.” So Salk initially made and tested his vaccine in secret. Thankfully, his promising preliminary results led to the March of Dimes launching the biggest clinical trial in the history of medicine. Beginning on April 26, 1954, with a six-year-old named Randy Kerr from McLean, Virginia, the trial eventually involved 1.5 million children, and had remarkable results: Salk’s vaccine was 80 to 90 percent effective in preventing paralytic polio. It was mass-produced and distributed around the country, and by the end of the decade, it had reduced the incidence of paralytic polio in the United States by 90 percent.

When the success of the vaccine trial was first announced, the public crowned Jonas Salk a national hero. He experienced a celebrity accorded few scientists in the history of medicine. Yet his rebuke by the scientific community had only just begun. As heads of states around the world rushed to honor him, scientists—the one group whose adulation he craved—remained ominously silent. Basil O’Connor, director of the National Foundation for Infantile Paralysis/March of Dimes, said they acted as if Salk had committed a felony. They accused Salk of failing to give proper credit to other researchers whose work had laid the foundation for his own. Salk in fact had tried to give them credit. But the media had made him the icon for polio, ignoring other scientists’ contributions. This set the stage for difficulties throughout Salk’s career wherein politics in and beyond the scientific community seemed to override good science.

In 1961, a public health decision was made to replace Salk’s vaccine with one developed by a virologist who constantly tried to discredit him, Albert Sabin. Sabin’s oral vaccine, made with a live virus, was cheaper and more convenient, but also much riskier; it actually caused polio in some cases. Salk worked throughout the rest of his life trying to reverse the decision—a sole warrior in a fight against what he considered entirely a politically-driven change. (In 1999, four years after his death, the Sabin vaccine was replaced with a new version of Salk’s vaccine, which is still used today.)

Salk also campaigned vigorously for mandatory vaccination, putting the health of the public foremost. He went as far as calling the immunization of all the world’s children a “moral commitment.” Thanks to his efforts—along with those of other researchers—we’re able to enjoy our summers without the fear of a crippling disease.

America now has been polio free for more than 35 years, and children are supposed to be vaccinated when they are babies. We’ve reached the point, however, where it seems many people can’t believe an epidemic could really occur. Some parents refuse vaccination, arguing that a healthy lifestyle is enough to protect their children from potentially lethal infections. But studies have shown that the introduction of sanitation actually enhances the circulation of poliovirus, because babies are no longer exposed to the virus in the very small amounts that used to produce lifelong immunity. Poliovirus can spread relentlessly once it gets a foothold in an unvaccinated community.

Such was the case shortly after Salk’s vaccine was released in 1955. Massachusetts closed its vaccination program because a manufacturing error led to some contaminated shots. Even though the mishap was quickly corrected, the state did not reopen its program. That summer, Massachusetts suffered one of its largest epidemics. Four thousand people contracted polio, and 1,700 were paralyzed—mostly children.

Does the public want to repeat history? I think Jonas Salk would plead with them to learn lessons from our past. Californians did with the recent measles outbreak, which affected more than 130 people, the majority of whom were unvaccinated. This helped spur the state to join Mississippi and West Virginia by mandating childhood vaccination, despite an outcry from several groups. Now if only 47 other states would follow suit.

Charlotte DeCroes Jacobs is a professor emerita at the Stanford University School of Medicine and the author of Jonas Salk: A Life. She wrote this for What It Means to Be American a national conversation hosted by the Smithsonian and Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

Seizing a Medicare Moment To Improve End-of-Life Care

Mildred Solomon is the President of The Hastings Center and Professor of Anesthesiology at Harvard Medical School. Nancy Berlinger is a Research Scholar at The Hastings Center.

It is crucial to ask people about what they want

Two announcements from the Centers for Medicare and Medicaid Services (CMS) represent welcome news in the long struggle to improve end-of-life care. One long-awaited change will reimburse physicians and other professionals, such as nurse practitioners and physician assistants, for conducting advance care planning with patients who wish to do so. The other change will expand the Medicare Care Choices Model, allowing more patients to receive services under the Medicare Hospice Benefit without forgoing interventions aimed at curing or controlling a terminal illness. This “Medicare moment” is an opportunity to include the 2.5 million people who die in the United States each year, and the millions of others who will be diagnosed with a life-threatening, usually age-associated condition, in health care system improvement, and to build on the American public’s hunger for better care as we near the end of life.

What, then, must we do to make sure these reforms stick, and to tackle the problems in end-of-life care that these reforms do not address?

First, we must get serious about training for health care providers who care for older Americans, so they are prepared to discuss patients’ end-of-life care preferences and support surrogate decision-makers who face the prospect of making decisions reflecting these preferences. Research, including a recent study published in JAMA Oncology, has shown again and again that simply completing forms or choosing a proxy does not provide a family member, or future health care providers, with the information they need to guide decision-making under stressful, real-life conditions. When decision-makers are confused about what to do for a dying patient, interventions escalate, a situation Atul Gawande, in his bestseller Being Mortal, rightly terms a “modern tragedy.” Now that Medicare has removed a financial barrier to health care providers holding advance care planning conversations, providers must acquire and practice certain basic skills. These skills include how to conduct an effective advance care planning process with a patient and, whenever possible, with this patient’s surrogate decision-maker; how to review and update advance care plans and explain options, including hospice, and how to integrate this ongoing process into appointments. Proven resources include the Respecting Choices program developed by Gundersen Health System, and the Alzheimer’s Association, which offers guidance on how to conduct advance care planning with patients with early-stage dementia. The Physician Orders for Life-Sustaining Treatment (POLST) model is a key resource when a patient faces foreseeable medical emergencies.

Second, professional societies that include providers who care for Medicare patients should make advance care planning, including explicit attention to how to discuss end-of-life care preferences, part of professional standards. Professional societies can create targeted resources, including mentoring, web-based education, and conference workshops, to help providers develop their skills and integrate them into practice. The American Society of Clinical Oncology and the American Association of Family Physicians are among the societies that have already begun to offer advance care planning guidance to their members. A new partnership between The Hastings Center and the Society of Hospital Medicine, aimed at improving end-of-life care in the hospital, will include guidance for frontline hospital clinicians on how to discuss care preferences as a patient’s condition changes. Advance care planning should also become an priority for Accountable Care Organizations (ACOs) and other networks that include hospitals, outpatient clinics, and medical groups, so care preference information elicited when patients are relatively healthy can actually inform their future care across different health care settings. There is not one “conversation” about the end of life, but many, over time, and our health care systems need to support ongoing discussion about issues that can be hard to talk about.

Finally, we know that people nearing the end of life often need a combination of medical and social services that are not fully covered by Medicare, state Medicaid programs, or private insurers. There is growing recognition that the long trajectory of frailty and dementia, combined with the size of the aging baby boomer generation, demands an infrastructure – ranging from respite programs and transportation, to home health aides and home care supplies, to residential care facilities – that our current health care workforce, facilities, and insurance mechanisms do not begin to meet. It is crucial to ask people about what they want. It is also crucial, as a matter of fairness in an aging society, to ensure that we have the capacity, now and in the decades ahead, to give people what they will need at the end of life.

 

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Diet/Nutrition

6 Brands Removing Artificial Chemicals From Their Products

Artificial colorings have been linked to everything from attention problems to obesity

Petroleum byproducts. Bug parts. Wood shavings. Duck feathers. If you can imagine it, you’re probably eating it every day as one of more than 3,000 natural and artificial chemicals that appear in our food supply. But after a decade of reporting on abominable additives, preposterous preservatives and crazy calorie counts, the editors at Eat This, Not That! are excited to report on a healthy new food trend: Major food manufacturers are finally stripping unnecessary chemicals from their products. And that may help you and your family strip off the pounds.

General Mills announced this week that it would eliminate artificial colors and flavors from its entire line of cereals, swapping out chemicals like red dyes (some of which have already been banned in most countries) for natural colorings from healthy sources like vegetables, joining Kraft, Nestle and other large companies in a race to clean up their acts.

Why is this such a great trend? Artificial colorings have been linked to everything from attention problems to obesity; in fact, studies show that people who eat highly processed foods tend to weigh more than those who don’t, even when calorie counts remain the same. Yet we really know very little about these chemicals: The Food and Drug Administration’s database of “Everything Added to Food in the United States” is really an America’s Most Unwanted list of additives, preservatives and flavor enhancers that food manufacturers (not the FDA itself, mind you) have decided are “generally recognized as safe.”

If you’ve been trying to cut artificial foods out of your life, take a second look at some of these products.

 

  • General Mills

    What they Promise: GM says that 60 percent of their cereals now don’t use artificial colors—like Cheerio’s and Chex—and that by the end of 2016, 90 percent will be completely free of artificial colors and flavors.

    Products: Eventually, this will include all cereals, including Trix, Lucky Charms and Reese’s Puffs.

    Why this is Great: A few years ago, researchers discovered that the artificial colors Yellow No. 5 and Yellow No. 6 may promote Attention Deficit Disorder (ADD) in children. In fact, Norway and Sweden have already banned the use of these artificial colors, and in the rest of the EU, foods containing these additives must be labeled with the phrase: “May have an adverse effect on activity and attention in children.”

    When it takes effect: The research is currently underway, and GM estimates that the entire line will be done by 2017, with cereals that include marshmallows, like Lucky Charms, the last to roll out.

  • Kraft

    Brand: Kraft

    What they Promise: The company announced this past spring that they would strip all artificial preservatives and synthetic colors from their iconic blue boxes of macaroni. They will replace the chemicals with those derived from natural sources like turmeric, paprika and annatto, a tree with vibrant orange-red seeds.

    Products: Original Kraft Macaroni & Cheese

    Why this is Great: Yellow 6, one of the colors currently being used in the pasta dish, contains benzidine and 4-amino-biphenyl, two known human carcinogens.

    When it takes effect: January 2016

  • Nestle

    What they Promise: The company announced earlier in the month that it would remove artificial flavors and “certified colors” in addition to reducing salt by 10 percent in its frozen pizza and snack products

    Products: Butterfinger, Baby Ruth, Digiorno, Tombstone, California Pizza Kitchen, Jack’s, Hot Pocket and Lean Pockets brands

    Why this is Great: We’re thrilled about the reduction of artificial colors—for the reasons mentioned above—but cheers to also reducing the sodium count. Sodium causes your body to retain water, which leads to pressure on your heart—and a rounder belly.

    When it Takes Effect: By the end of 2015.

  • Subway

    What they Promise: The sandwich chain announced earlier this month that they plan to remove preservatives and artificial colors and flavors from their core products

    Products: Sandwiches, salads, cookies and soups

    Why this is Great: Caramel coloring—which is currently being used in a number of their breads and meats—has been shown to cause cancer in animals and is a possible carcinogen for humans, too.

    When it Takes Effect: Over the next 18 months

  • Pizza Hut

    What they Promise: The popular pizza chain—once home to P’Zones, a calzone they described as “Over 1 pound of pizza goodness”—has been playing it both ways lately. Their just-announced Hot Dog Bites pizza plays to those looking for gross, mash-up pizzas, while in May, they also announced plans to remove artificial flavors from its pizzas. (Previously, they had removed MSG and partially hydrogenated oils.)

    Products: They promise to remove artificial flavors from the entire menu.

    Why this is Great: As the Pizza Hut CEO said: “Today’s consumer more than ever before wants to understand the ingredients that make up the foods that they enjoy.” But we’re also excited that they plan to reduce sodium in their pizzas, which will take effect next year.

    When it Takes Effect: The artificial flavors should be removed by the end of next month. Until then, learn which pies to avoid with this definitive list of The Worst Pizzas of 2015!

  • Panera

    What They Promise: The fast-casual restaurant chain promised to remove a long list of ingredients ranging from artificial preservatives and sweeteners to artificial colors and flavors, outlined in their published No-No List, from all of their products.

    Products: All.

    Why This Is Great: Titanium dioxide, only one of the ingredients getting the axe, is a whitening agent added to yogurts, marshmallows, even sunscreen, and Panera has historically used it in products like their mozzarella cheese. It’s a liquid metal, and worse: The International Agency for Research on Cancer (IARC) has classified it a possible carcinogen in humans. It has also been linked to asthma, emphysema, DNA breakdown, and neurological disorders.

    When It Takes Effect: By the end of 2016

    This article originally appeared on Eat This, Not That!

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TIME celebrities

Actress Valerie Harper Has Been Released From the Hospital

AARP The Magazine's 14th Annual Movies For Grownups Awards Gala - Arrivals
Gabriel Olsen—Getty Images Valerie Harper arrives for AARP the Magazine's 14th Annual Movies For Grownups Awards Gala in Beverly Hills, Calif., on Feb. 2, 2015

She was found unconscious before a theater performance

Actress Valerie Harper has been released from the hospital she was taken to in York, Maine, after being found unconscious backstage before a theater performance Wednesday, Deadline.com reports.

Harper, best known for playing Rhoda on The Mary Tyler Moore Show, revealed in 2013 that she has terminal brain cancer.

The 75-year-old has continued to work through her illness and is currently appearing along with Sally Struthers in the Gershwin musical Nice Work if You Can Get It. She spent Wednesday night receiving treatment and was discharged Thursday morning, Deadline.com says.

Harper has experience fighting cancer — she beat lung cancer in 2009 — and has endeavored to stay positive throughout her ordeal. “When I wake up in the morning, I don’t say, ‘Oh, I have cancer.’ I say ‘Another day. How you feeling? Good? Good,’” she told People in May.

TIME politics

How Medicare Came Into Existence

Aug. 6, 1965
Cover Credit: BORIS CHALIAPIN The Aug. 6, 1965, cover of TIME

TIME said the bill—signed on July 30, 1965—created a "welfare state beyond Roosevelt's wildest dreams"

It was 50 years ago Thursday, on July 30, 1965, that President Lyndon Johnson signed the Medicare bill, turning the national social security healthcare program for older Americans into law. But, despite Johnson’s legendary powers of legislative persuasion, the celebratory signing event—complete with the enrollment of the first Medicare beneficiary, former President Harry S. Truman—could have looked very different.

After all, the idea of helping American seniors afford health care took time to gain traction: The idea came up not long after Franklin Roosevelt initiated the modern social-security system in the 1930s. When the coinage “Medicare” first came on the American scene, the program it described was not the one we think of today. In 1960, the term referred to an opposing program proposed by the Eisenhower administration. The big fear at the time was that tying any kind of health aid to social security would quickly deplete the funds available for that then-30-year-old system; Eisenhower’s version, overseen by then-Vice President Richard Nixon, would have been both voluntary and state-funded.

In that year’s Presidential campaign, however, Nixon lost to challenger John F. Kennedy—who, as TIME put it a few years later, “vowed without qualification that his Administration would persuade a Democratic Congress to pass a medicare bill, to be financed under the social security system.” Kennedy died, however, before he could make good on that promise—which is where Johnson comes in. Benefiting from his 1964 election victory, Johnson made it happen. But what exactly it would look like remained to be settled.

By April of 1965, as TIME reported, there were three options in the running: Johnson’s social-security-linked compulsory program; an Eisenhower-esque voluntary program with no link to social security; or an American Medical Association-backed plan called “eldercare,” which prioritized patient choice and was need-based. The solution came, surprisingly, in the form of House Ways and Mean Committee chair Wilbur Mills, who had been a staunch opponent of Medicare. He combined elements of the three plans into one that would succeed. The basics of the plan were compulsory and funded by increasing social-security taxes, while extras were voluntary. The program we now know as Medicaid, for those in need, would also be expanded.

“The medicare bill will not solve all the problems of growing old—but it will certainly make the process much less costly to the elderly,” TIME noted. And that wasn’t all it did, the magazine continued. The medicare bill represented a fundamental change to American political norms:

Almost 30 years ago, Franklin Delano Roosevelt signed into law the Social Security Act. At the moment of signing, he issued a statement that, in retrospect, sounds almost apologetic: “We have tried to frame a law which will give some measure of protection to the average citizen and his family against the loss of a job and against poverty-ridden old age. This law, too, represents a cornerstone in a structure which is being built but is by no means complete. It is a structure intended to lessen the force of possible future depressions.”

Social security was mostly an emergency act in a nation still struggling out of the depths of a depression in which, in F.D.R.’s famed phrase, more than one-third of the nation was “ill-housed, ill-clad, ill-nourished.” The change since then in American life has never been more apparent than last week, when Congress acted on two bills that projected a new sort of welfare state beyond Roosevelt’s wildest dreams. First, the House of Representatives passed and sent to the Senate, where it faces certain swift approval, the Johnson Administration’s $6 billion-a-year medicare bill…

Action on both bills came not in time of depression but in the midst of the most prosperous year that the affluent society has ever known. There were a few squawks about presidential pressure, but it was widely accepted that both measures would achieve great good in making the U.S. even more affluent without turning it into a socialistic society. It was generally conceded that both bills, despite the vastness of their scope, were aimed not at increasing the power of the Federal Government, but at eradicating some remaining blemishes in the Great Society.

Read the full story, here in the TIME Vault: The New Welfare State

TIME medicine

Meet the Heroes and Villains of Vaccine History

A California legislator who faces a recall campaign for his support of a law mandating vaccinations is just one of the heroes in the history of vaccines. Alas, there are villains too

  • Edward Jenner

    Edward Jenner Vaccines
    Popperfoto/Getty Images Edward Jenner

    No one knows the name of the dairy maid 13-year old Edward Jenner overheard speaking in Sodbury, England in 1762, but everyone knows what she said: “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” Jenner was already a student of medicine at the time, apprenticed to a country surgeon, and the remark stayed with him. But it was not until 34 years later, in 1796, that he first tried to act on the dairy maid’s wisdom, vaccinating an 8-year-old boy with a small sample from another dairy maid’s cowpox lesion, and two months later exposing the same boy to smallpox. The experiment was unethical by almost any standard—except perhaps the standards of its time—but it worked. Jenner became the creator of the world’s first vaccine, and 184 years later, in 1980, smallpox became the first—and so far only—disease to have been vaccinated out of existence.

  • Jonas Salk and Albert Sabin

    Albert Sabin Jonas Salk Vaccines
    Mondadori/Getty Images; PhotoQuest/Getty Images Left: Albert Sabin in his laboratory in 1960; Right: Jonas Salk

    Jonas Salk and Albert Sabin didn’t much care for each other. The older, arid Sabin and the younger, eager Salk would never have been good matches no matter what, but their differences in temperament were nothing compared to a disagreement they had over science. Both researchers were part of the National Foundation for Infantile Paralysis—later dubbed the March of Dimes—and both were trying to develop a polio vaccine. Sabin was convinced that only a live, weakened virus could do the trick; Salk was convinced a newer approach—using the remains of a killed virus—would be better and safer. Both men turned out to be right. Salk’s vaccine was proven successful in 1955; Sabin’s—which was easier to administer, especially in the developing world, but can cause the rare case of vaccine-induced polio due to viral mutations—followed in 1962. Both vaccines have pushed polio to the brink of eradication. It is now endemic in only three countries—Afghanistan, Pakistan and Nigeria—and appears, at last, destined to follow smallpox over the extinction cliff.

  • Dr. Maurice Hilleman

    Dr. Maurice Hilleman Vaccines
    Ed Clark—Time & Life Pictures/Getty Image Dr. Maurice Hilleman (center) talks with his research team as they study the flu virus in a lab at Walter Reed Army Institute of Research, Silver Springs, Md. in 1957.

    Around the world, untold numbers of children owe their health to a single girl who woke up sick with mumps in the early morning hours of March 21, 1963. The girl was Jeryl Lynne Hilleman, who was then only 5; her father was a Merck pharmaceuticals scientist with an enduring interest in vaccines. Dr. Maurice Hilleman did what he could to comfort his daughter, knowing the disease would run its course; but he also bristled at the fact that a virus could have its way with his child. So he collected a saliva sample from the back of her throat, stored it in his office, and used it to begin his work on a mumps vaccine. He succeeded at that—and a whole lot more. Over the course of the next 15 years, Hilleman worked not only on protecting children against mumps, but also on refining existing measles and rubella vaccines and combining them into the three-in-one MMR shot that now routinely immunizes children against a trio of illnesses in one go. In the 21st century alone, the MMR has been administered to 1 billion children worldwide—not a bad outcome from a single case of a sickly girl.

  • Pearl Kendrick and Grace Eldering

    Pearl Kendrick Vaccines
    University of Michigan School of Public Health Pearl Kendrick

    It was not easy to be a woman in the sciences in the 1930s, something that Pearl Kendrick and Grace Eldering knew well. Specialists in public health—one of the only scientific fields open to women at the time—they were employed by the Michigan Department of Health, working on the routine business of sampling milk and water supplies for safety. But in their free time they worried about pertussis—or whooping cough. The disease was, at the time, killing 6,000 children per year and sickening many, many more. The poor were the most susceptible—and in 1932, the third year of the Great Depression, there were plenty of poor people to go around. A pertussis vaccine did exist, but it was not a terribly effective one. Kendrick and Eldering set out to develop a better one, collecting pertussis samples from patients on “cough plates,” and researching how to incorporate the virus into a vaccine that would provide more robust immunity. They tested their vaccine first on mice, then on themselves and finally, in 1934, on 734 children. Of those, only four contracted whooping cough that year. Of the 880 unvaccinated children in a control group, 45 got sick. Within 15 years of the development of Kendrick and Eldering’s vaccine, the pertussis rate in the U.S. dropped by 75%. By 1960 it was 95%—and has continued to fall.

  • Dr. Richard Pan

    Sacramento California News - June 30, 2015
    Madeline Lear—Sacramento Bee/ZUMA Wire June 30, 2015 - Sacramento, California - Senator Richard Pan (right) speaks during a press conference at William Land Park Elementary School in Sacramento on June 30, 2015, where vaccination advocates thanked the legislature and Gov. Brown for passing Senate Bill 277, which eliminates personal and religious belief exemptions for vaccines.

    The work that’s done at the lab bench is not the only thing that makes vaccines possible; the work that’s done by policymakers matters a lot too. That is especially true in the case of California State Senator Richard Pan, a pediatrician by training who represents Sacramento and the surrounding communities. Pan was the lead sponsor of the recently enacted Senate Bill 277, designed to raise California’s falling vaccine rate by eliminating the religious and personal belief exemptions that many parents use to sidestep the responsibility for vaccinating their children. For Pan’s troubles, he now faces a possible recall election, with anti-vaccine activists trying to collect a needed 35,926 signatures by Dec. 31 to put the matter before the district’s voters. Pan is taking the danger of losing his Senate seat with equanimity—and counting on the people who elected him in the first place to keep him on the job. “I ran to be sure we keep our communities safe and healthy,” he told the Sacramento Bee. That is, at once, both a very simple and very ambitious goal, made all the harder by parents who ought to know better.

  • Dr. Andrew Wakefield

    Dr. Andrew Wakefield Vaccines Autism
    Shaun Curry—AFP/Getty Images From right: Dr. Andrew Wakefield and his wife, Carmel arrive at the General Medical Council (GMC) in central London on Jan.28, 2010.

    Not every conspiracy theory has a bad guy. No one knows the name of the founding kooks who got the rumor started that the moon landings were faked or President Obama was born on a distant planet. But when it comes to the know-nothing tales that vaccines are dangerous, there’s one big bad guy—Andrew Wakefield, the U.K. doctor who in 1998 published a fraudulent study in The Lancet alleging that the MMR vaccine causes autism. The reaction from frightened parents was predictable, and vaccination rates began to fall, even as scientific authorities insisted that Wakefield was just plain wrong. In 2010, the Lancet retracted the study and Wakefield was stripped of his privilege to practice medicine in the U.K. But the damage was done and the rumors go on—and Wakefield, alas, remains unapologetic.

  • Jenny McCarthy and Jim Carrey

    Jenny McCarthy Jim Carrey Vaccines Autism
    Brendan Hoffman—Getty Images Jim Carrey (center) carries Evan McCarthy, son of actress Jenny McCarthy (left) during a march calling for healthier vaccines on June 4, 2008 in Washington.

    If you’re looking for solid medical advice, you probably want to avoid getting it from a former Playboy model and talk show host, and a man who, in 1994’s Ace Ventura: Pet Detective, introduced the world to the comic stylings of his talking buttocks. But all the same, Jenny McCarthy and Jim Carrey are best known these days as the anti-vaccine community’s most high-profile scaremongers, doing even the disgraced Andrew Wakefield one better by alleging that vaccines cause a whole range of other ills beyond just autism. None of this is true, all of it is shameful, and unlike Wakefield, who was stripped of his medical privileges, Carry and McCarthy can’t have their megaphones revoked.

  • Rob Schneider

    Rob Schneider Vaccines
    Richard Shotwell—Invision/AP Rob Schneider in 2014.

    What’s that you say? Need one more expert beyond Jenny McCarthy and Jim Carrey to weigh in on vaccines? How about Rob Schneider, the Saturday Night Live alum and star of the Deuce Bigalow, Male Gigolo films? Schneider has claimed that the effectiveness of vaccines has “not been proven,” that “We’re having more and more autism” as a result of vaccinations, and that mandating vaccines for kids attending public schools is “against the Nuremberg laws.” So, um, that’s all wrong. A vocal opponent of the new California law eliminating the religious and personal belief exemptions that allowed parents to opt out of vaccinating their kids, Schneider called the office of state legislator Lorena Gonzalez and left what Gonzalez described as a “disturbing message” with her staff, threatening to raise money against her in the coming election because of her support of the law. Gonzalez called him back and conceded that he was much more polite in person. Still, she wrote on her Facebook page, “that is 20 mins of my life I’ll never get back arguing that vaccines don’t cause autism with Deuce Bigalow, male gigolo.#vaccinateyourkids.”

  • Robert F. Kennedy, Jr.

    Robert Kennedy, Jr. Vaccines
    Rich Pedroncelli—AP Robert F. Kennedy, Jr. speaks against a measure requiring California schoolchildren to get vaccinated during a rally at the Capitol in Sacramento, Calif., on April 8, 2015.

    If you’re looking for proof that smarts can skip a generation, look no further that Robert F. Kennedy, Jr., son of the late Bobby Kennedy. RFK Jr. has made something of a cottage industry out of warning people of the imagined dangers of thimerosal in vaccines. An organomercury compound, thimerosal is used as a preservative, and has been removed from all but the flu vaccine—principally because of the entirely untrue rumors that it causes brain damage. But facts haven’t silenced Kennedy who, as a child of the 1950s and ‘60s, surely got all of the vaccines his family doctor recommended. Children of parents who listen to what he has to say now will not be so fortunate.

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