TIME health

How Dr. Alzheimer Discovered a Disease in a Mental Asylum

Alois Alzheimer
Alois Alzheimer (1864-1915) Apic / Getty Images

The unusual case seemed to stick out and the psychiatrist sensed that there was something special about Auguste. Dr. Alois Alzheimer decided that he should see Auguste for himself

History News Network

This post is in partnership with the History News Network, the website that puts the news into historical perspective. The article below was originally published at HNN.

Carl didn’t know what was happening to his wife. The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years. They had one daughter, Thekla, and their marriage had always been harmonious; that is, until one Spring day in 1901 when Auguste suddenly exhibited signs of jealousy.

Auguste accused Carl of going for a walk with a female neighbor, and since then, she had been increasingly mistrustful. Carl thought that this sudden jealousy was unfounded. Over the next several months, Auguste’s memory began to fade. The once orderly and industrious homemaker was making uncharacteristic mistakes in preparing home meals — a task that she had probably performed countless times. She wandered aimlessly around the apartment, leaving housework unfinished. She became convinced that a cart driver who frequented their house was trying to harm her and that people were talking about her. Without explanation, she began to hide various objects around the house. The couple’s neighbors sometimes discovered Auguste ringing their doorbells for no reason.

Prior to this change, Auguste had never been seriously ill. She was an otherwise healthy 51-year old woman who did not drink alcohol nor suffered from any mental illness. By November of 1901, Carl was at wit’s end. He had no choice but to take his wife to the local mental asylum. The physician’s admittance note described her as suffering from a weak memory, persecution mania, sleeplessness, and restlessness that rendered her unable to perform physical or mental work.

The following day, the senior physician at the Asylum for the Insane and Epileptic in Frankfurt am Main came across Auguste’s clinical notes. The unusual case seemed to stick out and the psychiatrist sensed that there was something special about Auguste. It was the case that he was waiting for. Dr. Alois Alzheimer decided that he should see Auguste for himself.

Over the next several months, Dr. Alzheimer interviewed and examined Auguste, whose condition continued to deteriorate. He asked her to name common objects, perform simple arithmetic, tell him where she lived, what year it was, the color of snow, the sky, grass, and so on. Alzheimer maintained a detailed record and even arranged for Auguste to be photographed. One photo reveals a woman with a deeply furrowed forehead and heavy bags under her eyes. She was wearing a white hospital gown and her face had a tired, blank expression, with perhaps a hint of fear. Her hands were draped over her raised knees, with the long fingers securely interlocked.

What struck Dr. Alzheimer was Auguste’s relatively young age. He had seen cases of mental deterioration in much older patients and had theorized that age-related thickening of the brain’s blood vessels led to brain atrophy. It was unusual, however, to see the condition in a person who was only fifty-one years old. Dr. Alzheimer had only encountered one other case similar to Auguste’s. The autopsy findings on that patient revealed shrinkage in specific brain cells but no significant blood vessel thickening.

Dr. Alzheimer continued his daily visits and long conversations with Auguste. There was no cure, of course, and the limited treatments included the use of sedatives and warm baths. At times, Auguste had to be placed in isolation after she groped faces and struck other patients in the clinic. She wandered aimlessly, sometimes screamed for hours, and became increasingly hostile. By February of 1902, her condition had advanced to the point that long conversations and physical examinations became impossible.

On April 8, 1906, after nearly five years of progressive mental and physical decline, Auguste died. The official cause of death was blood poisoning due to bedsores. Dr. Alzheimer suspected that behind her mental illness was a strange disease, and that perhaps examining her brain would offer some clues. When he examined the brain sections under the microscope, his suspicion was confirmed. Dr. Alzheimer described changes in the neurofibrils — the protein filaments found in brain cells. He also saw peculiar deposits that he referred to a “millet seed-sized lesions.” These pathologic findings — now known as neurofibrillary tangles and amyloid deposits – characterize the brains of Alzheimer’s Disease patients.

Dr. Alzheimer’s discovery was not immediately well received. In fact, the first time he presented Auguste’s case and autopsy findings during a German Psychiatry conference in 1906, the reception from the audience was rather cold. This was the time when psychoanalysis and the Freudian views on the relationship between childhood trauma and mental illness were, in today’s parlance, the “trending” topics in psychiatry. Correlating mental or neurologic disorders with histopathologic findings was not yet firmly established nor accepted. Ninety years later, in 1998, researchers re-examined Auguste’s original brain sections and confirmed the presence of neurofibrillary tangles and amyloid plaques.

Emil Kraepelin, one of the most prominent psychiatrists in the early 1900s, first mentioned the term ‘Alzheimer’s Disease’ in the 1910 edition of his textbook on psychiatry. The disease was of course still poorly understood, but one of the most famous medical eponyms was born.

Today, there are an estimated five million Americans diagnosed with Alzheimer’s Disease. The number is expected to rise as the population ages. There is no cure, and the burden on the afflicted as well as caregivers remains tremendous. The economic burden is also substantial, with healthcare costs for dementia in general estimated to be over $200 billion dollars in 2010. Researchers are on a quest to find effective treatment in areas that include stem cell and gene therapy.

Rod Tanchanco is a physician specializing in Internal Medicine. He writes about events and people in the history of medicine. His personal blog is at talesinmedicine.com.

References

Maurer K. Alzheimer : the life of a physician and the career of a disease. New York: Columbia University Press; 2003.

Graeber MB, Kösel S, Grasbon-Frodl E, Möller HJ, Mehraein P. Histopathology and APOE genotype of the first Alzheimer disease patient, Auguste D. Neurogenetics. 1998;1(3):223–8

TIME Behind the Picture

The Photo That Changed the Face of AIDS

LIFE.com shares the story behind one of the most harrowing and controversial photographs to emerge from the global pandemic

In November 1990 LIFE magazine published a photograph of a young man named David Kirby — his body wasted by AIDS, his gaze locked on something beyond this world — surrounded by anguished family members as he took his last breaths. The haunting image of Kirby on his death bed, taken by a journalism student named Therese Frare, quickly became the one photograph most powerfully identified with the HIV/AIDS epidemic that, by then, had seen millions of people infected (many of them unknowingly) around the globe.

Here, a quarter-century later, LIFE.com shares the deeply moving story behind that picture, along with Frare’s own memories of those harrowing, transformative years.

“I started grad school at Ohio University in Athens in January 1990,” Frare told LIFE.com. “Right away, I began volunteering at the Pater Noster House, an AIDS hospice in Columbus. In March I started taking photos there and got to know the staff — and one volunteer, in particular, named Peta — who were caring for David and the other patients.”

David Kirby was born and raised in a small town in Ohio. A gay activist in the 1980s, he learned in the late Eighties — while he was living in California and estranged from his family — that he had contracted HIV. He got in touch with his parents and asked if he could come home; he wanted, he said, to die with his family around him. The Kirbys welcomed their son back.

[See all of TIME.com’s coverage of HIV/AIDS]

Peta, for his part, was an extraordinary (and sometimes extraordinarily difficult) character. Born Patrick Church, Peta was “half-Native American and half-White,” Frare says, “a caregiver and a client at Pater Noster, a person who rode the line between genders and one of the most amazing people I’ve ever met.”

“On the day David died, I was visiting Peta,” Frare, who today lives and works in Seattle, told LIFE. “Some of the staff came in to get Peta so he could be with David, and he took me with him. I stayed outside David’s room, minding my own business, when David’s mom came out and told me that the family wanted me to photograph people saying their final goodbyes. I went in and stood quietly in the corner, barely moving, watching and photographing the scene. Afterwards I knew, I absolutely knew, that something truly incredible had unfolded in that room, right in front of me.”

“Early on,” Frare says of her time at Pater Noster House, “I asked David if he minded me taking pictures, and he said, ‘That’s fine, as long as it’s not for personal profit.’ To this day I don’t take any money for the picture. But David was an activist, and he wanted to get the word out there about how devastating AIDS was to families and communities. Honestly, I think he was a lot more in tune with how important these photos might become.”

Frare pauses, and laughs. “At the time, I was like, Besides, who’s going to see these pictures, anyway?

Over the past 20 years, by some estimates, as many as one billion people have seen the now-iconic Frare photograph that appeared in LIFE, as it was reproduced in hundreds of newspaper, magazine and TV stories — all over the world — focusing on the photo itself and (increasingly) on the controversies that surrounded it.

Frare’s photograph of David’s family comforting him in the hour of his death earned accolades, including a World Press Photo Award, when published in LIFE, but it became positively notorious two years later when Benetton used a colorized version of the photo in a provocative ad campaign. Individuals and groups ranging from Roman Catholics (who felt the picture mocked classical imagery of Mary cradling Christ after his crucifixion) to AIDS activists (furious at what they saw as corporate exploitation of death in order to sell T-shirts) voiced outrage. England’s high-profile AIDS charity, the Terrence Higgins Trust, called for a ban of the ad, labeling it offensive and unethical, while powerhouse fashion magazines like Elle, Vogue and Marie Claire refused to run it. Calling for a boycott of Benetton, London’s Sunday Times argued that “the only way to stop this madness is to vote with our cash.”

“We never had any reservations about allowing Benetton to use Therese’s photograph in that ad,” David Kirby’s mother, Kay, told LIFE.com. “What I objected to was everybody who put their two cents in about how outrageous they thought it was, when nobody knew anything about us, or about David. My son more or less starved to death at the end,” she said, bluntly, describing one of the grisly side effects of the disease. “We just felt it was time that people saw the truth about AIDS, and if Benetton could help in that effort, fine. That ad was the last chance for people to see David — a marker, to show that he was once here, among us.”

David Kirby passed away in April 1990, at the age of 32, not long after Frare began shooting at the hospice. But in an odd and ultimately revelatory twist, it turned out that she spent much more time with Peta, who himself was HIV-positive while caring for David, than she did with David himself. She gained renown for her devastating, compassionate picture of one young man dying of AIDS, but the photographs she made after David Kirby’s death revealed an even more complex and compelling tale.

Frare photographed Peta over the course of two years, until he, too, died of AIDS in the fall of 1992.

“Peta was an incredible person,” Frare says. Twenty years on, the affection in her voice is palpable. “He was dealing with all sorts of dualities in his life — he was half-Native American and half-White, a caregiver and a client at Pater Noster, a person who rode the line between genders, all of that — but he was also very, very strong.”

As Peta’s health deteriorated in early 1992 — as his HIV-positive status transitioned to AIDS — the Kirbys began to care for him, in much the same way that Peta had cared for their son in the final months of his life. Peta had comforted David; spoken to him; held him; tried to relieve his pain and loneliness through simple human contact — and the Kirbys resolved to do the same for Peta, to be there for him as his strength and his vitality faded.

Kay Kirby told LIFE.com that she “made up my mind when David was dying and Peta was helping to care for him, that when Peta’s time came — and we all knew it would come — that we would care for him. There was never any question. We were going to take care of Peta. That was that.

“For a while there,” Kay remembers, “I took care of Peta as often as I could. It was hard, because we couldn’t afford to be there all the time. But Bill would come in on weekends and we did the best we could in the short time we had.”

Kay describes Peta, as his condition worsened in late 1991 and 1992, as a “very difficult patient. He was very clear and vocal about what he wanted, and when he wanted it. But during all the time we cared for him, I can only recall once when he yelled at me. I yelled right back at him — he knew I was not going to let him get away with that sort of behavior — and we went on from there.”

Bill and Kay Kirby were, in effect, the house parents for the home where Peta spent his last months.

“My husband and I were hurt by the way David was treated in the small country hospital near our home where he spent time after coming back to Ohio,” Kay Kirby said. “Even the person who handed out menus refused to let David hold one [for fear of infection]. She would read out the meals to him from the doorway. We told ourselves that we would help other people with AIDS avoid all that, and we tried to make sure that Peta never went through it.”

“I had worked for newspapers for about 12 years already when I went to grad school,” Therese Frare says, “and was very interested in covering AIDS by the time I got to Columbus. Of course, it was difficult to find a community of people with HIV and AIDS willing to be photographed back then, but when I was given the okay to take pictures at Pater Noster I knew I was doing something that was important — important to me, at least. I never believed that it would lead to being published in LIFE, or winning awards, or being involved in anything controversial — certainly nothing as epic as the Benetton controversy. In the end, the picture of David became the one image that was seen around the world, but there was so much more that I had tried to document with Peta, and the Kirbys and the other people at Pater Noster. And all of that sort of got lost, and forgotten.”

Lost and forgotten — or, at the very least, utterly overshadowed — until LIFE.com contacted Frare, and asked her where the photo of David Kirby came from.

“You know, at the time the Benetton ad was running, and the controversy over their use of my picture of David was really raging, I was falling apart,” Frare says. “I was falling to pieces. But Bill Kirby told me something I never forgot. He said, ‘Listen, Therese. Benetton didn’t use us, or exploit us. We used them. Because of them, your photo was seen all over the world, and that’s exactly what David wanted.’ And I just held on to that.”

After the Benetton controversy finally subsided, Therese Frare went on to other work, other photography, freelancing from Seattle for the New York Times, major magazines and other outlets. While the world has become more familiar with HIV and AIDS in the intervening years, Frare’s photograph went a long way toward dispelling some of the fear and, at times, willful ignorance that had accompanied any mention of the disease. Barb Cordle, volunteer director at Pater Noster when David Kirby was there, once said that Frare’s famous photo “has done more to soften people’s hearts on AIDS than any other I have ever seen. You can’t look at that picture and hate a person with AIDS. You just can’t.”

[See more of Therese Frare’s work at FrareDavis.com]

TIME Cancer

The Hidden Dangers of Medical Scans

medical scans
Getty Images/Flickr RF

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.

HEALTH.COM: 9 Everyday Sources of Radiation

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.

HEALTH.COM: 15 Diseases Doctors Often Get Wrong

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.”

HEALTH.COM: 6 Key Medical Scans and What They Should Cost

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.

HEALTH.COM: 20 Quick and Easy Ways to Get Healthier Fast

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.

HEALTH.COM: 19 Medical Tests Everyone Needs

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.

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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?

birth control pills
Getty Images

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.

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