TIME Cancer

The Hidden Dangers of Medical Scans

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Medical imaging tests are exposing more of us to potentially cancer-causing radiation. Here's when you really need that scan—€”and when you should just say no

Over the past ten years, Jill Nelson, 52, a health coach, personal trainer and counselor in Chicago, has received at least seven computed tomography (CT) scans and close to 30 sets of X-rays for a variety of health ailments—from two separate disk fusions in her spine to a worrisome-looking spot on her lung. That’s on top of the 10 or so mammograms she has had since age 35, plus dozens of dental X-rays. “With all that radiation, I’m surprised I don’t glow,” she says. “It makes me a little uneasy—in trying to get my health problems diagnosed, did I increase my risk of cancer?”

Jill’s concern is shared by a growing number of doctors and medical organizations, who are worried about the soaring use of medical imaging tests that rely on ionizing radiation. This radiation can damage your cells’ DNA, which may, over time, lead to cancer. The more you’re exposed to, the riskier it is. And thanks to the increase in CT scans—which typically emit far higher doses of radiation than traditional X-rays or even other imaging tests like mammograms—exposure has risen dramatically. In 1980, only about 3 million CT scans were performed in the United States. By 2013, that number had skyrocketed to 76 million.

Exactly how dangerous are all those zaps? In 2009, National Cancer Institute researchers estimated that the 72 million CT scans performed in 2007 could lead to as many as 29,000 future cases of cancer. And a couple of years ago, when the Institute of Medicine looked broadly at the environmental causes of breast cancer, it concluded that one factor that’s strongly associated with risk of developing the disease is ionizing radiation.

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That sounds scary—and it is. “Limiting exposure to medical radiation should be on every woman’s cancer-prevention list,” says Rebecca Smith-Bindman, MD, professor of radiology, epidemiology, biostatistics and health policy at the University of California, San Francisco. Yet the tests are widely overused, research finds. “About a third of CT scans are clinically unnecessary or could be avoided by using conventional X-rays or an imaging test that doesn’t use radiation, like ultrasound or MRI,” says David J. Brenner, PhD, director of the Center for Radiological Research at Columbia University Medical Center.

The challenge is figuring out whether the CT your doctor wants you to have is essential or not—a judgment call that is difficult for the average person to make. CT scans can, in fact, be lifesaving. “They’ve revolutionized medicine in almost every area you can imagine, including helping prevent unnecessary exploratory surgeries and diagnosing and treating cancers, heart disease and stroke, ” Brenner says. Price and time can also be a factor since CT scans are cheaper and faster than an MRI. (For a cost comparison of common imaging tests, go to health.com/scan-costs.)

Understanding the risks of medical radiation—as well as the real benefits—will better prepare you to make the best decision no matter when you’re faced with it. Here’s what you must know to avoid unneeded radiation.

Weighing the rewards and risks

When you receive a traditional X-ray, a small amount of radiation passes through your tissues in order to create a two-dimensional image of your insides in shades of gray. Air is black because it doesn’t absorb any X-rays, while bones are white because they absorb a lot, and organs are somewhere in between.

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CT scanners, on the other hand, rotate around the body, sending numerous X-ray beams (and multiple times the amount of radiation) from a variety of angles. A computer processes the data to create three-dimensional pictures, providing a far more detailed view. “CTs allow us to see behind and around structures in the body in three dimensions with exquisite resolution,” Brenner says. As a result, they’re an indispensable tool in diagnosing all sorts of frightening health problems, such as finding small, early cancers (particularly in the lungs, liver and kidneys) or spotting internal injuries after a serious accident.

“They can detect differences between normal and abnormal tissue about 1,000 times better than a traditional X-ray,” says Richard Morin, PhD, professor of radiologic physics at the Mayo Clinic in Jacksonville, Fla. “Before CTs, if we suspected cancer in the abdomen or internal organs, we had to cut the patient open and do exploratory surgery, which could mean a weeks-long hospital stay. Now with a single scan we can confidently make the call in minutes, and the patient walks out the door afterward. If it’s an appropriately ordered exam, the benefit is far, far greater than any radiation risk.”

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But the ease and accuracy of CTs has also fueled an alarming level of overuse. Have a headache that prompts a trip to the ER? Odds are good you’ll get a CT, even though current guidelines say that doctors shouldn’t perform imaging tests on patients with migraines or chronic headaches. Brain scans, whether a CT or an MRI, are worthwhile only if you have a headache with other worrisome symptoms, such as weakness or numbness on one side of your body, explains Brian Callaghan, MD, a neurologist at the University of Michigan. Even so, he and his colleagues recently found that about one in eight headache-related doctor visits result in a brain scan—and nearly half those patients are getting CTs, even though MRIs are more effective for peering into the brain.

“The goal isn’t to eliminate CTs but to use them more prudently,” Dr. Smith-Bindman says. “When my son did a head-dive out of a tree and was vomiting afterward, the ER doc recommended a CT scan to rule out a brain bleed, and I was happy to have the test. Five years later, when he hit his head skiing, it was pretty clear he just had a concussion, and the ER doc didn’t think a CT was necessary, so we didn’t get it. Doctors and patients need to step back a little and say, ‘Yes, this is a great test, but is it really necessary?’ If you have a CT when it’s not necessary, it won’t do any good—which means it can only do harm.”

The radiation equation

X-rays and CT scans use so-called ionizing radiation, which contains enough energy to penetrate the body—and can damage DNA in your cells. Any damage that isn’t repaired can lead to DNA mutations, and those glitches in a cell’s programming center can, over many years, lead to cancer.

And we know that it does. “There’s not a single cancer-causing agent that has been studied more thoroughly than ionizing radiation,” Dr. Smith-Bindman says. Survivors of the atomic bombs in Hiroshima and Nagasaki who were exposed to even very low doses were more likely to get practically every type of cancer, from leukemia to lung cancer. Nursing mothers who were treated with radiation for breast infections—a common practice in the 1920s and ’30s—developed breast cancer at higher rates than those who weren’t. Those of us who’ve had more sunburns (caused by the sun’s ultraviolet radiation) are at higher risk of getting skin cancer. And the newest studies reveal that children who undergo CT scans of the head, abdomen or chest are more likely to develop brain cancer and leukemia over the next 10 years.

For reasons that are unclear, women seem to be slightly more sensitive to radiation than men. Children are more vulnerable than adults; not only do their growing bodies and rapidly multiplying cells put them at a higher risk, they also have far more years ahead of them during which they could develop cancer.

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However, it’s important to note that our bodies are able to repair damage done to our cells by low levels of radiation. “If they weren’t, everyone who goes out in the sun would get skin cancer,” points out James Brink, MD, radiologist in chief at Massachusetts General Hospital.
The poison is in the dose, says John Boice, ScD, president of the National Council on Radiation Protection and Measurements and professor of medicine at Vanderbilt University. And the effects of exposure might be cumulative. “What may happen is that our bodies repair damage from small doses, but at higher doses our repair mechanisms are overwhelmed,” Dr. Brink explains. “And after that, subsequent exposure to radiation may propel the damaged cells farther down the path toward cancer.”

The actual danger to an individual receiving a scan (or even two or three) is relatively low. The overall risk of the average woman getting cancer at some point in her lifetime is about 38 percent; getting a single CT scan raises that risk to perhaps 38.001 percent, Boice explains. But since no one knows who is most likely to be affected, there is an element of radiation roulette at play.

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What’s more, we’re marinating in low-level radiation every day. The average person in the United States receives about 3 millisieverts (mSv) of radiation per year (more if you live at a high altitude) from the sun and naturally occurring radiation in the environment, such as radon gas. To put medical radiation in that context, a dental X-ray is equivalent to about one day of natural radiation, while a single chest X-ray is equivalent to about 10 days. A mammogram adds up to about seven weeks of natural radiation—but even that level, doctors say, poses a relatively small risk, especially when compared with the danger of missing a malignant tumor already growing in your breast. A regular-dose chest CT, on the other hand, exposes you to about two years’ worth of natural background radiation, or 7 mSv. Some of the Japanese survivors of atomic bombs were probably exposed to between 5 and 20 mSv on the low end. The trouble is, we don’t fully know how much our bodies can handle.

What doctors don’t know can hurt us

The issue of medical radiation is now on most physicians’ and medical societies’ radars; just this fall, the American Heart Association called for doctors to learn about, and discuss with patients, the risks of radiation exposure from cardiovascular imaging tests. So it’s surprising—and concerning—how spotty regulations still are. For instance, dosages aren’t standardized across imaging centers, which means that one hospital or clinic may be delivering up to 50 times as much radiation as another facility, according to Dr. Smith-Bindman. “If machines are set too low, they provide blurry, unusable images, but the vast majority are set higher than they need to be,” she says. This is in part because it’s not a simple matter of pressing one button and lowering the dose. “There are formulas you need to use to set up a new protocol,” Dr. Smith-Bindman explains.

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And because most older machines, many of which are still in use, don’t have warning systems to alert technologists when radiation levels are set too high, mistakes can happen. The most publicized CT-related overdoses occurred between 2008 and 2010, when several hospitals in California and one in Alabama seriously over-radiated more than 400 patients. The problem was discovered after patients reported losing their hair. Since then, new technology has been created to alert technologists if the dose is too high—and new federal legislation is in the works that would require radiology centers to adopt modern imaging equipment standards by 2016.

Still, the more common problem is that too many scans are being done in the first place, particularly in the ER, where doctors sometimes order CTs before they’ve fully evaluated a patient, Dr. Smith-Bindman says. But doctors in general have come to rely heavily on these tests. One reason: Many MDs today have a lower tolerance for ambiguity than ever before and have learned to trust images to give them definitive answers, even when other methods, including a risk-free physical exam, can provide the information needed.

In addition, physicians in private practice may feel financial pressure to recoup the cost of expensive equipment. “Research has found that if a neurologist, say, owns a CT scanner, the percentage of patients getting scans is higher than what’s typically done in a radiology clinic and much higher than in similar doctors’ practices without scanners,” Morin says. Add to the mix the possibility of being sued over a misdiagnosis, and you have a recipe for overuse.

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Making scans safer

Avoiding unnecessary medical radiation starts with speaking up and being your own best advocate (see 5 Questions to Ask Before You Have That Scan, page 117). At the same time, multiple industry efforts are under way to lower exposures from CTs. One initiative, Choosing Wisely (choosingwisely.org), helps doctors and patients understand which procedures and tests—including imaging tests—are unnecessary or commonly overused. Radiologists are leading the charge to make scans safer: Image Wisely, a program created by the American College of Radiology (ACR) and the Radiological Society of North America, is focused on optimizing the amount of radiation used in imaging studies and eliminating inessential CTs and other scans. The ACR has also created the Dose Index Registry in an effort to compare dosage information across facilities. About a third of the 3,000 or so scanning facilities in the U.S. are members, which means they get updates on the dosages other centers are using for similar tests, explains Morin, who was the founding chair of the registry. (For more on finding the best place to get a scan, go to health.com/safe-scan.)

HEALTH.COM: 5 Medical Tests to Think Twice About

Meanwhile, companies that manufacture scanners are developing new technology to lower the radiation doses. “They’ve fine-tuned the equipment so you can produce high-quality images with lower doses,” Morin says. Even so, when you need to get a CT scan, it’s always a good idea to ask if they can scan using the lowest dose possible, Dr. Smith-Bindman says. If you’re smaller or thinner, technicians can often get a clear image at a lower dose. (The bigger your body, the more radiation you require, since fat absorbs some of the beams.) Avoid unnecessary radiation from even low-level sources, like dental X-rays, which you probably don’t need every year unless you have ongoing problems with tooth decay.

The idea is not to refuse all medical radiation but to do your best to discriminate between what’s essential and what’s not. “I always tell my friends to say to their doctors who recommend CTs, ‘I’m happy to have the test, but I’d like you to help me understand why I really need it,’” Dr. Smith-Bindman says. “Medicine often doesn’t change until patients start asking questions. And when it comes to medical radiation, it’s time to start asking.”

5 Questions to ask before you have that scan
“When a doctor prescribes a medication, she always talks about the risks and benefits,” says Rebecca Smith-Bindman, MD. “Now we need to start having that same kind of discussion about medical imaging.” In addition to the obvious “Why do I need this test?” ask these key questions—especially if your doc suggests a CT scan.

1. “Will the outcome of the test change the treatment I’m likely to receive?” If the answer is no, the test may not be necessary, Dr. Smith-Bindman points out.

2. “Are there alternatives without radiation, like ultrasound or MRI?” In some cases, such as many abdominal CT scans, other scans work as well or better, Dr. Smith-Bindman says.

3. If you’ve just had a scan at another facility, ask, “Is there a reason to repeat the scan I just had?” Notes John Boice, ScD: “It doesn’t make sense to do tests twice, yet it does happen.”

4. If a CT scan is crucial, ask, “Is there a way to minimize the dose?” Doctors may be able to use a lower-dose technique, particularly if you’re petite.

5. After a CT scan, ask, “How much radiation was I exposed to?” Write it down so you have a record.

You probably don’t need a CT for… Question your doc if she recommends a CT for these health problems.

Concussion: Concussions can be diagnosed by symptoms alone. But it’s valid to do a CT if the doctor suspects a skull fracture or brain bleed, says Robert Cantu, MD, clinical professor of neurosurgery at Boston University School of Medicine.

Sinus infection: This everyday health problem can generally be diagnosed through symptoms and a physical exam, says the American Academy of Allergy, Asthma & Immunology.

HEALTH.COM: 10 Medical Tests Women Need This Year

Headache: If you do need a scan, MRI is the test of choice, unless a doctor suspects a stroke or brain hemorrhage, according to the American Headache Society.

Appendicitis in children: It’s best to use ultrasound first, then follow up with a CT if the ultrasound is inconclusive, according to the American College of Radiology.

Back pain: Most cases improve on their own within a month, so it doesn’t make sense to expose yourself to unnecessary radiation. If the pain continues, ask your doctor about an MRI.

How much radiation you get from…
Airport backscatter scan: .0001 mSv
Bone-density scan: 0.001 mSv
Dental posterior bite-wing X-ray series (two to four images): 0.005 to 0.055 mSv*
Two days in Denver: 0.006 mSv
Panoramic dental X-rays (standard single image): 0.009 to 0.024 mSv*
Cross-country flight: 0.04 mSv
Single chest X-ray: 0.1 mSv
Digital mammogram: 0.4 mSv
Average yearly dose from the sun and other environmental sources: 3 mSv
Chest CT: 7 mSv
Virtual (CT) colonoscopy: 10 mSv

PET/CT (often used to diagnose cancer): 25 mSv

Smoking a pack a day for a year: 53 mSv

*Dose can vary based on the type of machine used.

Your anti-radiation diet
Antioxidants from food can sop up the free radicals that cause DNA damage. And some research has hinted that what you eat may shield your body from radiation’s harmful effects. A 2009 study of airline pilots, who tend to be exposed to elevated levels of ionizing radiation, found that those with diets highest in vitamins C and E, beta-carotene, beta-cryptoxanthin (found in pumpkin, papaya and red peppers) and lutein-zeaxanthin (in leafy greens, egg yolks and squash) had fewer biomarkers of cumulative DNA damage.

Researchers in Toronto have recently shown that taking antioxidants before a scan can reduce the number of DNA breaks caused by the radiation. Published results are expected within the next six months. Says researcher Kieran Murphy, MD, professor of radiology at the University Health Network Toronto: “In light of what we’ve found, making sure you have a diet rich in antioxidant-packed fruits and vegetables could be beneficial.”

This post originally appeared on Health.com

TIME Parenting

The 5 Trends Driving the Surge in ADHD

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Researcher says it's less to do with brain chemistry and more to do with money

Until recently, 90% of all Ritalin takers lived in the U.S. Now, America is home to only 75% of Ritalin users. But that’s not because Americans are using less of the drug, says a Brandeis professor. That’s because ADHD diagnoses, and treatment via pharmaceuticals are growing in other parts of the world.

In a recent paper in the journal Social Science and Medicine, sociologists Peter Conrad and Meredith Bergey looked at the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil and found that prescriptions for Ritalin-like drugs have risen sharply, particularly in the U.K. and Germany.

Attention Deficit Hyperactivity Disorder, or ADHD, is a controversial subject among many parents, educators and medical professionals. Some doctors insist it’s a genuine neurological condition, if occasionally over-diagnosed and not treated properly. Others believe parents are giving their children drugs unnecessarily. (For a look at what it’s like to be, or parent, an ADHD child, read TIME’s special report, Growing Up with ADHD).

Conrad and Bergey, while not doctors, fall into the second camp. They list five possible reasons for the jump in ADHD diagnoses that have little do with medicine.

1) Pharmaceutical companies are well-resourced and determined lobbyists, and have coaxed some countries to allow stimulants, such as Ritalin and Adderall to be marketed more directly.

2) Treating patients with counseling and non medical therapies is becoming less popular than treating them with medicine. (Many insurers, including Medicaid, will pay for drugs but not for psychotherapy, for example.)

3) The Diagnostic and Statistical Manual (DSM), the bible of mental disorders, is gaining more traction in Europe and South America. The DSM has slightly broader standards for diagnosing ADHD than the system used by many other countries, the International Statistical Classification of Diseases and Related Health Problems (ICD), hence more folks are falling within the standard.

4) ADHD advocacy groups are raising awareness of the condition.

5) Because everybody is occasionally fidgety and distracted and nearly everybody despairs of not getting enough done, people turn to the internet for answers and find checklists put up by drug companies, with overly general questions like: “Are you disorganized at work and home?” and “Do you start projects and then abandon them?” and encourage people to ask their doctors about medication.


According to the study, fewer than 1% of kids in the U.K. had been diagnosed with ADHD in the 1990s, but about 5% are today. In Germany, prescriptions for ADHD drugs rose 500% over 10 years, from 10 million daily doses in 1998 to 53 million in 2008. Conrad, author of The Medicalization of Society, worries that we may be addressing a sociological problem with a chemical solution.

“There is no pharmacological magic bullet,” says Conrad, who suggests that the one-size-fits-all compulsory education system might be more to blame for kids who can’t sit still rather than a flaw in brain chemistry.

“I think we may look back on this time in 50 years,” writes Conrad, “and ask, what did we do to these kids?”

TIME medicine

‘Bubble Boy’ Disease Cured With Stem Cells

Alysia Padilla-Vacarro and daughter Evangelina on the day of her gene therapy treatment. Evangelina, now two years old, has had her immune system restored and lives a healthy and normal life.
Alysia Padilla-Vacarro and daughter Evangelina on the day of her gene therapy treatment. Evangelina, now two years old, has had her immune system restored and lives a healthy and normal life. Courtesy of UCLA

Researchers have treated more than two dozen patients with a treatment made from their own bone marrow cells

Alysia Padilla-Vaccaro and Christian Vaccaro owe their daughter’s life to stem cells. Evangelina, now two, is alive today because she saved herself with her own bone marrow cells.

Evangelina, a twin, was born with a severe immune disorder caused by a genetic aberration that makes her vulnerable to any and all bacteria and viruses; even a simple cold could be fatal. But doctors at University of California Los Angeles (UCLA) Broad Stem Cell Research Center gave her a new treatment, using her own stem cells, that has essentially cured her disease. She’s one of 18 children who have been treated with the cutting-edge therapy, and the study’s leader, Dr. Donald Kohn, says that the strategy could also be used to treat other gene-based disorders such as sickle cell anemia.

Known to doctors as adenosine deaminase (ADA)-deficient severe combined immunodeficiency (SCID), it’s better known as “bubble boy” disease, since children born with the genetic disorder have immune systems so weak that they need to stay in relatively clean and germ-free environments. Until Evangelina and her sister Annabella were 11 months old, “We were gowned and masked and did not go outside,” says their mother Alysia Padilla-Vaccaro. “Our children did not physically see our mouths until then because we were masked all the time. We couldn’t take them outside to take a breath of fresh air, because there is fungus in the air, and that could kill her.”

Both parents wore masks at work to lower the chances they would be exposed to germs that they might bring back home. And they took showers and changed clothes as soon as they entered the house.

MORE: Gene-Therapy Trial Shows Promise Fighting ‘Bubble Boy’ Syndrome

SCID is caused by a genetic mutation in the ADA gene, which normally produces the white blood cells that are the front lines of the body’s defense against bacteria and viruses. The Vaccaros decided to treat Annabella in the same way that they cared for Evangelina; “They were crawling and playing with each other, and every toy they sucked on, they stuck in each other’s hands and each other’s mouth, so we couldn’t take one outside to have a grand old time and potentially bring something back that could harm her sister,” says Padilla-Vaccaro.

Christian and Alysia Padilla-Vaccaro and their healthy twins Annabella (left) and Evangelina. Now with a newly-restored immune system, Evangelina lives a normal and healthy life. Courtesy of UCLA

The only treatments for SCID are bone marrow transplants from healthy people, ideally a matched sibling; the unaffected cells can then repopulate the immune system of the baby with SCID. But despite being her twin, Annabella wasn’t a blood match for her sister, nor were her parents. Padilla-Vaccaro and her husband, Christian, were considering unrelated donors but were concerned about the risk of rejection. “We would be trying to fix one problem and getting another,” she says.

MORE: Stem Cells Allow Nearly Blind Patients to See

That’s when the doctors at the Children’s Hospital at Orange County, where Evangelina was diagnosed, told her parents about a stem cell trial for SCID babies at UCLA, led by Dr. Donald Kohn. “As soon as they said trial, I thought, ‘my kid is dead,” says Padilla-Vaccaro of the last resort option. But a dozen children born with other forms of SCID—in which different mutations caused the same weak immune systems—who were successfully treated by Kohn convinced the couple that the therapy was worth trying. Kohn had one spot left in the trial and was willing to hold it for Evangelina until she matured more. Born premature, she was diagnosed at six weeks old and needed more time for what was left of her immune system to catch up to weather the procedure.

When she was two months old, Evangelina was admitted to UCLA and had bone marrow drawn from her tiny hip. It contained the stem cells that go on to develop into all of the cells in the blood and immune systems. Kohn treated them with gene therapy, co-opting a modified virus to carry the healthy ADA gene so it could infect the stem cells from Evangelina’s bone marrow. The idea was that by transplanting these healthy ADA-containing cells back into Evangelina, she would soon be making her own healthy immune cells. And because they were made from her own cells, her body wouldn’t reject them.

MORE: Woman Receives First Stem Cell Therapy Using Her Own Skin Cells

“After the transplant of this miraculous tube of stem cells, which literally took five minutes, we had to just wait and see for a good six weeks,” says Padilla-Vaccaro. “The week after Christmas [in 2012], Dr. Kohn came in and told me, ‘It worked.’ It worked. Those words…besides the birth of my children, that day will always be the best day in my life.”

The success was a long time coming for Kohn as well. His group has been researching the best way to treat SCID with gene therapy for more than two decades. In the first trial, in 1993, they used cord blood, treating it with the healthy ADA gene and hoping enough of them would “take” to rebuild an immune system. It didn’t work.

In 2001, they tried a different way of delivering the precious gene in four patients. That failed as well.

MORE: Type 1 Diabetes Treatment Gets Boost from Stem Cells

Then, in 2009, he and his team began the trial that Evangelina eventually joined. After reading about a group in Italy that completely obliterated the patients’ existing immune systems with chemotherapy first, before introducing the new bone marrow cells to repopulate the system, Kohn tried that strategy on 10 babies. “Of all the patients we treated, all have had good immune reconstitution,” he says. “Within a month or two, we start seeing cells appear in the blood that are making the missing gene. When they are six months old or so, their immune systems are good enough for them to go out and not be protected, and by age two, they are pretty stable—their immune systems are reset.”

That’s where Evangelina is now, able to finally enjoy the world outside her home and the hospital. She got her first kisses from her parents when she was 18 months old. “My worry was that I couldn’t raise my daughter without her sister,” says Padilla-Vaccaro. “Now I don’t have to.”

TIME Health Care

Don’t Count on Smart Baby Monitors To Prevent SIDS

New "smart" products to monitor babies shouldn't quell parents' fears about SIDS

Parents often rely on home monitoring products to protect babies from sudden infant death syndrome (SIDS), an unexplained death that can happen to seemingly healthy babies, often during sleep. But they shouldn’t, argues a new editorial report in the journal The BMJ.

David King, author of the piece and clinical lecturer in pediatrics at the University of Sheffield, wrote that smart baby monitors and infant wearables provide a false sense of security to parents who use the products to keep their babies safe.

Take Owlet, King says, a U.S. company that raised $1.85 million in April 2014 for a smart sock that could measure babies’ vital signs. Other companies like Rest Devices and Sproutling have advertised similarly smart clothing for monitoring babies’ vitals. The problem, King argues, is that while the companies don’t outright claim that their products reduce the risk of SIDS, parents’ fears of the disorder are responsible for spurring the industry’s growth.

In August, Sproutling co-founder and CEO Chris Bruce told TIME the product was developed out of his own need to incessantly check on his baby to make sure she was still breathing. “I’d get nervous,” he said. “I tried to listen at the door and I didn’t want to wake her up…So I sneak in, I try and listen if she’s breathing, and I end up putting my hand on her and waking her up.”

King writes that devices can be helpful in some circumstances. “Home monitoring may be justified in some situations, such as for preterm infants or infants who need oxygen,” he says. “But in these cases parents and other caregivers should be trained in observation techniques, operation of the monitor, and infant cardiopulmonary resuscitation.” These monitoring products do not require premarket approval by the US Food and Drug Administration (FDA), and King argues that despite the fact that the companies disclose that they are not medical devices, there’s not enough information ensuring parents really know that. He argues that the advertising for these products is confusing.

In the report, King writes:

Owlet states on its website that the device “alerts you if something appears wrong with your baby’s heart rate or the amount of oxygen in his/her body.” Rest Devices claims that its product allows parents to see their “baby’s breathing patterns, in real-time.” Sproutling says that it will let you know “if your baby is sleeping soundly or if something is wrong.” No published data support any of these claims, and because the devices are being sold as consumer rather than medical devices such data are not required. Ideally, manufacturers would be required to undertake observational studies or randomized trials to support any claims they make concerning the utility and efficacy of wearable devices in infants—even if they are categorized as consumer devices.

The American Academy of Pediatrics has already said that home cardiorespiratory monitors shouldn’t be used to reduce SIDS risk.

In response to King’s report, the founder of Owlet Kurt Workman says in a statement sent to TIME: “I have hundreds of comments from Owlet testers and none of them focus on SIDS. They just want to know if something is wrong. That’s what pulse oximetry does in hospitals and in homes worldwide. Parents simply want something that can monitor their child pro-actively (something that video and sound can’t do). As parents we’re tired of monitors that only serve a purpose when we’re awake. We want something that can let us rest easier. That’s the purpose of Owlet and for many parents it is worth the expense.”

Rest Devices, the company behind the Mimo Smart Baby Monitor, also responded to TIME:

Mimo was never designed to be a medical device. It’s worth noting that our founding team did clinically validate our sensors when doing early-stage development of adult respiratory diagnostic devices, and we continued to use that knowledge base once we transitioned to baby and family products. We do communicate to our customers in several different forms that our product is a baby monitor, not a medical device. It’s on our website, it’s on our packaging, it’s in our support tools—including the setup booklet that helps a parent get up and running.

Owlet says nearly 3,000 people have pre-ordered their product and that their technology is more advanced than the research King mentions in his piece. “The bigger point is that technology has progressed and we can now fit a pulse oximeter, accelerometer and even temperature sensors comfortably on a baby’s foot without any cords,” says Workman, adding that the company is creating a product that they will submit to the FDA as a medical device to take home from the neonatal intensive care unit.

“Some professionals have the notion that the less parents know the better, we feel the opposite,” he says. “We also feel that they have the right to know more about their child.”

King says medical professionals should not recommended the products to ease parents’ fears, but should instead recommend methods long known to work, like positioning a child on its back to sleep. But in our new age of tracking ourselves, why not keep tabs on the vitals of our dependent kin? Smart monitoring devices won’t hurt as an extra way for parents to track their children—as long as they’re well aware that doing so won’t alert them to SIDS in their babies.

Sproutling did not respond to requests for comment at publication.

TIME medicine

Science Says These Are the Best Ways to Swallow Pills

Human hand hold medicine
Yasser Chalid—Moment Open/Getty Images

Lean forward or lean back?

For anyone who has ever choked or spit water out while trying to swallow a pill (which, let’s face it, we all have), a new study finally has answers for you.

The study published in the Annals of Family Medicine sought to determine the effectiveness of swallowing pills with what it called the “pop-bottle method” and the “lean forward technique.” The pop-bottle method had participants place the pill on their tongue and swallow it in one motion with a drink from a plastic bottle, and the lean forward technique had subjects swallow the capsule in an upright position with their heads bent forward.

The study found that both techniques “substantially facilitated” swallowing pills, even in subjects who had previously reported difficulty. Between the two methods, people preferred the lean forward technique—88.5% of participants reported improvement with the pop-bottle technique, and 96.9% did with lean forward.

So next time you face the daunting task of swallowing a pill, try tipping your head forward.

TIME health

Refusing Quarantine: Why Typhoid Mary Did It

Typhoid Mary Cooking
Illustration of 'Typhoid Mary' also known as Mary Mallon breaking skulls into a skillet, circa 1909. Fotosearch / Getty Images

Nov. 11, 1938: Mary Mallon dies in isolation on a New York island after being blamed for giving 51 people typhoid fever

In the early 1900s, when typhoid fever was associated with slums and their dismal sanitation, epidemiologists — and everyone else — wanted to know why an outbreak of the deadly bacterial infection suddenly emerged in Long Island’s tony Oyster Bay, among the summer homes of wealthy New Yorkers.

The answer turned out to be a cook who trailed typhoid wherever she went. And while Mary Mallon responded by brandishing a meat fork whenever public officials tried to test her, she proved to be a carrier for the disease, which was fatal to about one in 10 people who acquired it, even though she herself was immune to its effects.

Her extreme contagiousness (the New York Times called her “a veritable peripatetic breeding ground for the bacilli”) coupled with her refusal to comply with health officials’ orders not to endanger the public — say, by cooking for them — led to her lengthy involuntary isolation and to her moniker: Typhoid Mary.

It’s a name that invariably crops up whenever the debate over treatment of potential disease-carriers reenters the public discourse, as it did last month when a nurse returning from Sierra Leone was quarantined in a tent for three days. Although the nurse — who tested negative for Ebola — later balked at a voluntary three-week quarantine at her home in Maine, she faced nothing close to what Mary endured: more than a quarter-century of isolation on a “pest island” in the East River that ended with her death on this day, Nov. 11, in 1938.

For officials who, then as now, walked a fine line between protecting the public and preserving the civil rights of individuals who might pose a health risk, Mary presented a complicated case. The picture of health, despite her habit of infecting her employers, she refused to believe that she could make others sick without being sick herself, and swore until the day she died that she wasn’t responsible for the epidemic that perpetually followed in her wake.

That key difference between typhoid and Ebola — the latter of which is only contagious when the infected person is symptomatic, whereas Mallon was extremely contagious but never symptomatic — is also why Typhoid Mary’s usefulness as a current-events talking point is limited. Her resistance to quarantine was not based on science, and her health made it particularly hard to hold her to her promises. For example, she swore not to take another job as a cook when she was released in 1910, after three years of isolation in Riverside Hospital on the now-abandoned North Brother Island. Health officials lost track of her for a few years, but found her again in the midst of another typhoid outbreak, this time at a Manhattan maternity hospital where 25 people, mostly doctors and nurses, were infected. Mary had been cooking there under a fake name, but fled before health officials could catch her. They traced her to a house in Queens, where they had to sneak in through a second-story window, using a ladder, to apprehend her, according to the Times report on the event.

From there, it was back to isolation — for 23 more years, the rest of her life. Her obituary in the Times blamed her for 51 cases of typhoid and three deaths. Putting her age at roughly 68, the obit noted that “while her system was loaded with typhoid germs to such an extent that some physicians referred to her as the human culture tube, it was not typhoid that caused her death,” but the effects of a stroke she’d suffered six years earlier.

Read a 1928 report on New York City’s isolation island, here in TIME’s archives: Public Health

TIME Innovation

Five Best Ideas of the Day: November 10

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Food touches everything in our lives. Yet we have no national food policy. That must change.

By Mark Bittman, Michael Pollan, Ricardo Salvador and Olivier De Schutter in the Washington Post

2. Electronic Medical Records should focus more on patient care and less on meeting the needs of insurance companies and billing departments.

By Scott Hensley at National Public Radio

3. Anonymous social media often hosts vicious harassment targeting women and minorities. A new plan to monitor threats online is working for a solution.

By Barbara Herman in International Business Times

4. “You can’t wear a Band-Aid for long, particularly when the wound keeps bleeding.” Two years after Hurricane Sandy, New York is far from stormproof.

By Lilah Raptopoulos in the Guardian

5. China and the U.S. should take aim at a new “grand bargain” to head off tensions and mistrust in their relationship.

By Wei Zongyou in the Diplomat

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

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 women

Did We Give the Pill Too Much Power?

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Elizabeth Weingarten is the associate editor at New America and the associate director of its Global Gender Parity Initiative.

The answer to why we are still struggling with reproductive rights in this country may have to do with our original—and perhaps unrealistic—expectations of how much the pill could change things in the first place

This pill came with a promise: help extinguish sexism from public life by removing a key roadblock for women. If women could plan when and whether they became pregnant, they should be better able to develop careers and livelihoods, avoid a life of economic dependence on men, and form identities outside of motherhood.

In many ways, the birth control pill kept that promise by enabling women to enter the workforce, improving their health by helping them to space out pregnancies, and allowing them to have sex for pleasure. But more than 50 years after the pill first came to market, its promise of access and equality remains unfulfilled for millions of other women.

Think about the Hobby Lobby decision, which ruled that certain businesses can deny employees coverage for contraception on the basis of religious beliefs. The fact that many insurance plans still don’t cover contraception or infertility treatments. “Time passes and yet we’re still kind of stuck when it comes to reproductive rights,” said New York Times Health reporter Catherine Saint Louis at a recent New America NYC event. Cost and culture still prevent millions of low-income women here and abroad from obtaining the pill.

“The things we’re talking about [today] are the same things [Margaret Sanger, one of the pill’s bankrollers and the founder of Planned Parenthood] was talking about in 1914,” said Jonathan Eig, the author of the book, “The Birth of the Pill.” “I honestly believe she thought once the pill got out there, the genie would be out of the bottle, women would have all the power they needed and everything would be fine after that… I really think she’d be stunned.”

So how did we get here?

At least in part, the answer may lie in the scope of our expectations; we have asked a lot of one medical invention. After all, said Eig, the idea that the role of a woman is to be a vessel for a child is rooted in thousands of years of history. This biological difference is the foundation of gender inequality – the thing that for centuries kept them out of economic and professional competition with men, noted New Republic Senior Editor Rebecca Traister.

That’s a powerful dynamic and hard to reverse. The pill turned into a silver bullet, that single technological innovation that would allow us to avoid confronting the deeper, more impactful social structures that sustain gender discrimination. We can’t ask the pill and its users to fix a problem the rest of us choose to ignore.

Here in the U.S., the pill put “all of the onus and responsibility [of pregnancy] on individual women without a sense of accountability of community and government to support whole and healthy lives,” explained Tiloma Jayasinghe, the executive director of the anti-violence against women organization Sakhi for South Asian Women. But “we’re not in this by ourselves.”

It also sidelined men, taking their responsibility out of the equation and separating them from the reality of reproduction, Traister said. “That’s how you get Rush Limbaugh talking about, ‘how much sex are these women having that they have to pay this amount per pill?’ What it has done is further made reproduction ‘women’s territory’ in certain ways.”

“It was a double-edged sword,” said Eig.

Even when companies clumsily try to give agency to women, it illustrates how much society has put women in an untenable situation. Facebook and Apple announced recently that they would begin offering egg freezing as part of their healthcare benefit plans. Critics accused the tech companies of putting pressure on women to sacrifice life for work, and decried the use of egg freezing as dangerous. But that criticism is misguided, argued Traister. Rather than blame Facebook and Apple, why not fault a “system that repeatedly puts new possibilities on offer and keeps them from people who need them”? Everyone, not just tech companies, should offer these types of benefits because they’re part of women’s health, she said.

Improving women’s health is a major benefit of the pill. Before the pill, birth control was inefficient, inaccessible, and often completely controlled by men. Consequently, women were having more children than they wanted – often faster than their bodies could handle them. In many cases, this led to maternal and infant death, or economic instability and famine.

That’s still the case overseas, where Silver Bullet laziness may also be a factor. Though the pill has led to many health benefits, including a reduction in infant and maternal deaths around the world, its effects have been uneven and limited in certain developing countries. “The WHO and other organizations are promoting the use of the pill to space pregnancies, and yet they are doing so in countries where women don’t always have control of their bodies or access to the pill,” Jayasinghe said. She suggested that the pill’s success may lead to complacency in those regions: “We have it now, our work is done. But it’s not done.”

So how do we change the system here and abroad?

For many countries, harnessing the power of the pill will require a major culture shift. It needs to become okay for mothers to talk to daughters and fathers to talk to sons about contraception, which won’t be an easy fix, Jayasinghe said. (And critically, contraception is much more than just the pill. There are other forms of more reliable contraception – like IUD and hormonal implants – that in some cases are even preferred by women, but may be pricier or harder to access).

Here in the U.S., “we need to broaden our discussions to beyond fighting about abortion to a fuller scope of what do rights mean – the full scope of contraception,” Jayasinghe said. Abortion is just one issue in a women’s life – and making it a nitpicky focal point of reproductive conversations is limiting, she suggested. Ideally, legislators would introduce – and pass – some kind of comprehensive women’s reproductive rights and healthcare bill. That also means recognizing infertility as a real health problem, Saint Louis noted. Right now – in many circles – it’s an “I’m so sorry you waited until you were 35 [to have kids] problem, rather than recognizing that it affects 19-year-olds.”

It’s also critical to include men in conversations – both personal and public – around reproductive issues. Research shows that when men and women are required to take sexual education classes together, for example, birth rates drop dramatically, Eig pointed out. And after all, the scientific mastermind behind the pill was a man – Gregory (Goody) Pincus.

“There’s still a long way to go,” Eig said. “If there were more people like Goody [Pincus] fighting today, we’d see more innovation and more attention still being brought to this cause.”

This piece was originally published in New America’s digital magazine, The Weekly Wonk. Sign up to get it delivered to your inbox each Thursday here, and follow @New America on Twitter.

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 medicine

9 Things to Know Before Buying Another Supplement

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A guide to avoiding sketchy ingredients and choosing the most trusted brands

The supplement aisle at the drugstore is lined with products that promise to prevent illness, improve energy, boost metabolism, even brighten your skin. You probably already know these capsules aren’t necessarily silver bullets to perfect health. (Whatever benefits your multivitamin or omega-3 supplements offer, you still have to exercise and eat right, for example.) But you do expect them to be safe to swallow, at the very least.

Sadly, a new study in the Journal of the American Medical Association suggests otherwise. After analyzing supplements that had been recalled by the FDA for containing banned substances—such as steroids or powerful prescription medications like Viagra and Prozac—researchers found that roughly two-thirds of the tainted products were back on store shelves with the same illicit ingredients at least six months later.

HEALTH.COM: 6 Myths (and Facts) About Weight Loss Supplements

Because supplement makers are subject to little regulatory oversight from the U.S. Food & Drug Administration, they aren’t required to prove a product’s safety (or efficacy) before it goes to market. And as this study shows, some fail at accurately providing the most basic safety information.

That said, the supplement industry is vast; Americans are expected to spend $32.4 billion on vitamins and dietary supplements in 2014, according to a Euromonitor International report. And there are reputable, safe supplement-makers out there.

Our buyer’s guide can help you avoid sketchy ingredients and choose the most established, trusted brands.

Be wary of certain types of pills

Namely exercise, weight-loss, and sexual-enhancement supplements. The products analyzed in the JAMA study fell into these three categories. Several of the weight-loss supplements actually contained an amphetamine-like drug called sibutramine, which is banned in the U.S., Asia, and Europe.

HEALTH.COM: Warning: Do Not Mix These Supplements

Shop selectively

Big-chain drugstores, pharmacies, and supplement stores like GNC or the Vitamin Shoppe may act faster to pull recalled items.

Don’t bargain-hunt

A University of Minnesota analysis found that for six types of herbal products, the more expensive the supplement was, the more likely it was that the recommended dosage would be consistent with established standards.

Steer clear of supplements made in China

Lack of regulation and poor manufacturing practices in China mean their goods may be more likely to be contaminated with substances like lead.

HEALTH.COM: Probiotic Foods and Supplements That Really Work

Check for a USP Verified Mark

It means that the nonprofit US Pharmacopeia has verified that a product contains the ingredients on the label in the amounts specified and doesn’t contain unacceptable levels of contaminants.

Do research at reputable sites

You can read supplement fact sheets from National Institutes of Health Office of Dietary Supplements to get all the info you need on everything from the recommended daily amount (RDA) to the latest on the health benefits of a certain supplement. It’s also a good idea to stay on top of warnings or recall alerts from the FDA. When you’re ready to buy, the USP website has a store directory and list of all the participating supplement companies if you want to check before you head to the store.

HEALTH.COM: Vitamins: What to Take, What to Skip

Consult the experts

Namely, the store pharmacist and your doctor. The former can alert you to any potential adverse events or drug interactions, and your doc can advise you on which supplements are safe and effective.

Skip dubious ingredients

These four have been linked to serious side effects, and aren’t worth the risk.

  1. Kava. It has been reported to cause liver damage.
    2. Bitter orange. It contains the chemical syndephrine, which has been linked to heart attacks and strokes in healthy people when taken alone or combined with caffeine.
    3. Contaminated L-tryptophan. It’s associated with neurotoxic reactions.
    4. Chromium. When overused, it’s been linked to anemia—even kidney failure.

HEALTH.COM: Best Foods For Every Vitamin and Mineral

With additional reporting by Hallie Levine

This article originally appeared on Health.com

TIME health

Pilot Sully Sullenberger on Ebola: Medicine Needs a Higher Authority

Chesley "Sully" Sullenberger in New York City, on Jan. 15, 2014.
Chesley "Sully" Sullenberger in New York City, on Jan. 15, 2014. Andrew Burton—Getty Images

Sully Sullenberger is an expert in the fields of aviation and patient safety.

Quality and safety oversight of the medical field is too fractured, and could benefit from an FAA-like agency

For the last several weeks, I have been watching the haphazard response to the appearance of Ebola in the U.S. through the eyes of a professional pilot. With limited federal control over matters related to public health, elected officials around the country are rushing to enact emergency measures to prevent Ebola’s spread, resulting in major disagreements about how best to do that. We saw the limits of that approach in New Jersey, and then in Maine, when the first person subjected to forced isolation called her treatment “inhumane” and defied quarantine orders, setting off a debate among public health experts, civil liberties groups and even the White House.

I have devoted my entire professional life to the pursuit of the safety of the public. Aviation and medicine are both high-stakes endeavors with little margin for error. All complex systems are different, but they all abide by similar rules and need a coordinated system of protocols and uniformity to bring into play under situations that can be very different. Over many decades, aviation has developed a systems approach to manage the complexity and interrelatedness of an endeavor that involves inherent risk, and an effective culture of safety that can, in substantive ways, be transferred to medicine.

When an accident occurs in aviation – often resulting in mass casualties and widespread media attention – the National Transportation Safety Board (NTSB) immediately conducts a thorough investigation into the accident or incident as the U.S. body responsible for recommending systemic changes and making sure that the right lessons are drawn and disseminated widely to all in the industry. In medicine there are too many entities that have a hand in quality and safety and whose efforts are not effectively coordinated. The Centers for Disease Control and Prevention (CDC) lacks the high degree of regulatory authority of an agency like the Federal Aviation Administration (FAA), so there is no single domestic agency that oversees all of medicine and promotes and mandates agreed upon best practices uniformly. And Ebola aside, in medicine, accidents and incidents tend to occur singly, largely without getting much attention.

Without a systems approach, medicine is fragmented. Without sufficient widespread implementation of best practices and effective training, medical personnel and government leaders are forced to scramble, making critical decisions and developing protocols in real time to respond to an evolving crisis. With states and hospitals left to their own devices, no one consistent policy emerges, causing gaps in execution. The result, as we have seen, can lead to chaos and confusion among medical professionals and a loss of confidence by the public.

In aviation we also face complexity, ambiguity and situations we have never specifically trained for, but airline pilots train for the unknown. It is our job to anticipate potential issues and, when faced with the unexpected, to adapt, and to respond calmly, quickly and effectively. The ability to make split-second decisions becomes infinitely easier when the effective protocols, training, equipment and human team skills are already in place as part of the robust and resilient safety system and culture in which we operate. Every day pilots and flight attendants face new situations for the first time at 35,000 feet, but they perform successfully because they know how to execute after years of preparedness training. They’re not trying to use duct tape to solve the problem.

Medical professionals are as dedicated as any. They grapple with imperfect information, highly complex systems and ambiguities that far outweigh those of a Boeing 747. But that’s all the more reason to create a culture of consistent application of best practices and effective communication. In order to establish and maintain public confidence, officials have to handle uncertainty well, acknowledge the limits of their knowledge and have the courage to level with people. Every time I made an announcement from the cockpit, whether it was about a delay or an in-flight emergency, I told my passengers everything that I knew and that I would keep them updated. That kind of transparency is the only way to maintain the public’s trust.

The aviation industry has made great strides in safety over the past 40 years by teaching critical skills some call “soft” skills, which are really human skills, giving crews the tools they need to take a team of experts and make them an expert team. In an overall systems approach, there are real incentives aligned with the public good, and we’ve found that a long-term approach to safety pays for itself by avoiding accidents and bad outcomes.

In medicine, there is so much uncoordinated individual effort on the part of thousands of entities, it is hard to align public health incentives and take the long-term approach. There were candidate Ebola vaccines ready to go to human trial almost 10 years ago. As we’ve learned in aviation, safety is cost-effective in the long term, and for that reason we have for decades used government-industry partnerships to do the hard work and proactively mitigate risks.

Adopting some of these practices may help avoid the systemic gaps we’ve seen over the last few weeks, resulting in better alternatives for those tasked with the heavy burden of managing the Ebola response – and for the public at large.

Sully Sullenberger is an expert in the fields of aviation and patient safety; he is an author, speaker and consultant, and serves as the CBS News Aviation and Safety Expert. He is also the founder and chief executive officer of Safety Reliability Methods, Inc., a company dedicated to management, safety, performance and reliability consulting.

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.

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