TIME tobacco

The FDA’s Frightening Anti-Smoking Campaign for Teens Hits Them Where It Hurts

FDA Tobacco Campaign

The agency's ads will feature rotting teeth and premature wrinkles

The last time the U.S. Food and Drug Administration (FDA) tried to use graphic images to deter smokers in 2012, a judge ruled its graphic labels–which included images of rotting lips, corpses, and diseased lungs–unconstitutional. Two years later, the FDA has revealed its latest move, announcing its first national anti-smoking campaign aimed at teens. At first look, the result is similarly dramatic, though slightly less frightening: One ad features a teen pulling out a tooth with a wrench to pay for a pack of cigarettes, while another simply focuses on a young woman with wrinkles.

Called The Real Cost,” the campaign aims to decrease the number of teens between the ages 12 and 17 from becoming hooked on tobacco by emphasizing the bodily harm smoking can inflict–and tapping into teens’ concerns about their appearance. “The FDA has collaborated with some of the brightest and most creative minds to develop a multimedia initiative designed to make the target audience acutely aware of the risk from every cigarette by highlighting consequences that young people are really concerned about,” said Mitchell Zeller, director of the FDA’s Center for Tobacco Products said in a statement. The campaign also underscores the addictive quality of nicotine, since many young people presume they can quit whenever they want.

The ads, which will begin appearing nationwide on Feb. 11, will be seen in 200 different markets on TV, radio, print, and online. You can watch a preview here:

Before launch, the FDA conducted massive ad testing and found the ads to be memorable and engaging among their target audience. The agency plans to track the effectiveness of the campaign by monitoring 8,000 people between the ages of 11 and 16 for two years to see whether there are any changes in tobacco knowledge and attitudes. “As a regulatory agency, everything the FDA does is grounded in science,” Zeller said.

Tobacco use had a sharp drop among teens between 1997 and 2003, but began to slow in 2003 and came to almost a halt between 2009 to 2011, according to data released from the CDC in 2012. Health experts speculate that the reasons for the range from lower state dedication to the cause to teen’s growing interest in other products like small cigars. Emerging research shows that teens are also taking a liking to e-cigarettes, which don’t contain tobacco but still have nicotine.

The FDA’s latest initiative is part of their overall move to tighten their control over the tobacco industry. Every day, more than 3,200 young people under the age of 18 try their first cigarette, and more than 700 of them will become daily smokers. It is the leading cause of preventable disease, disability, and death in the U.S., and responsible for 480,000 deaths every year.

Under the 2009 Family Smoking Prevention and Tobacco Control Act–which gives the FDA the power to regulate the manufacturing, distribution, and marketing of tobacco products–tobacco companies are required to foot the $115 million for the awareness campaign. “The Real Cost” is the first of several campaigns the agency plans to roll out over the next few years, with subsequent efforts targeting specific audiences from rural teens to LGBT youth.

TIME Sexual Health

Don’t Worry: The HPV Vaccine Isn’t Changing Pre-Teens’ Views About Sex

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The vaccine, which protects against cervical cancer and sexually transmitted infections, does not do much to change pre-teens' views or behaviors surrounding sex

The latest study on the role that the human papillomavirus (HPV) vaccine may play on young girls’ sexual behavior shows what public health experts have long maintained — that the shot, which protects against the virus that causes genital warts, does not lead teenage girls or young women to start having unsafe sex. Nor does it change the opinions of girls who already think unsafe sex isn’t a big deal.

The new analysis, published in the journal Pediatrics, comes from researchers at Cincinnati Children’s Hospital Medical Center, who studied more than 300 young women between the ages of 13 and 21 right after they received the HPV vaccine, and again six months later. The researchers asked the girls about their views on a variety of sex-related issues, such as what they thought about the risk of contracting a sexually transmitted infection (STI) other than HPV after the vaccination and whether they were sexually active.

MORE: HPV vaccine protection lasts more than 6 years

Their answers showed that getting the vaccine did not change their sexual activity, nor did it alter their perceptions of how likely they were to get an STI such as HPV. The vaccine also did not modify how they felt about safe sex; getting immunized also did not affect whether they thought they would get other STIs.

The researchers concluded that that vaccine therefore does not lead to riskier behaviors, as some anti-vaccine advocates have worried, and believe the data should help doctors to improve vaccination rates; currently, a third of eligible girls and only 7% of boys in the U.S. who should receive the shot have gotten all three doses.

HPV is a common sexually transmitted disease that affects about 79 million Americans, according to the Centers for Disease Control, and about 14 million new people will be infected each year. Although most HPV infections resolve on their own, the virus is also the most common cause of cervical cancer, which is why federal health experts added the shot to the childhood immunization schedule in 2007 for girls aged 11 or 12, and for boys of the same age in 2011 in the hopes of protecting people from both STIs and cancer as early as possible.

TIME Cancer

WHO: Annual Cancer Cases To Hit 22 Million

Up from 14 million a year in 2012

Cancer cases worldwide could hit 22 million a year within the next two decades, according to the World Health Organization.

The agency’s World Cancer Report 2014 estimated that the cancer burden for 2012 was 14 million new cases a year, but said the rate was expected to jump much higher over the next twenty years as the number of elderly people worldwide increases.

Developing countries will see the brunt of the growing cancer rate due to population growth, according to the report. Some 60 percent of the world’s cancer sufferers are in Africa, Asia, and Central and South America. These same countries make up 70 percent of cancer deaths worldwide.

The report said improvements in early detection and access to treatment could bring the number down. The report says that greater access to vaccines for diseases like hepatitis B virus and human papillomavirus (HPV) could greatly lower cancers in the liver and cervix. Tobacco prevent efforts could also play a major role and lowering the high levels of lung cancer. According to 2012 data, the most common cancers were lung, breast, and large bowel. The most common deaths from cancer were for diseases of the lung, liver and stomach.

“Governments must show political commitment to progressively step up the implementation of high-quality screening and early detection programmes, which are an investment rather than a cost,” says report co-author Dr. Bernard W. Stewart in a statement.

The International Agency for Research on Cancer report is a collaboration between 250 scientists from more than 40 countries.

TIME brain injury

The Best Concussion-Proof Helmets

Virginia Tech

A new study shows that one helmet may protect against concussions better than others

Concussions are an unfortunate reality in many sports, from football to soccer and boxing. And as studies continue to link concussions to a range of health problems, from depression to Alzheimer’s and other brain changes, sports and health officials have focused their attention on whether protective equipment like helmets can lower the risk of brain injuries.

Most research to date shows that there is no concussion-proof helmet to protect against all concussions and brain injury. In March 2013, a panel of 32 experts updated the Consensus Statement on Concussion in Sport, and concluded that while mouth guards and helmets generally protect the faces and heads of athletes, they don’t do much to protect them from internal brain damage. In fact, they warned, helmets and mouth guards may even give some players a false sense of security and invincibility and may make them act more aggressively on the field.

MORE: A New Blood Test to Diagnose Concussions On The Field

A new study published in the Journal of Neurosurgery confirmed that there’s no helmet that can protect a player from all concussions, but the researchers compared two helmets and found that some can be more protective than others. While previous studies simply looked at rates of concussions across a wide variety of helmet types and among players with varying rates of head impacts, in this study the scientists were able to control for the number of impacts each player had and compare that to his helmet type and risk of concussion. The researchers analyzed six years of head impacts among 1833 college football players from eight schools. The players were either wearing a Riddell VSR4 or Riddell Revolution helmet, which the manufacturers say no longer have screws that are typically found in the forehead area of the helmet. That construction provides “an unparalleled amount of face mask flexion, dispersing impact energies around the helmet instead of onto the player’s head,” the company claims. The two helmets were popular choices at the time of the study.

(MORE: Your Kid Is Probably Wearing the Wrong Helmet to Prevent Concussions)

The research team monitored more than a million head impacts by equipping the helmets with sensors to measure the force, velocity and direction of each impact. They found a 54% lower risk of concussion among players wearing the Riddell Revolution helmet compared to those who wore the VSR4 helmet. That suggests that the Revolution is better at dissipating the energy from an impact on the helmet before it reaches the head, leading to what the researchers call lower head accelerations and a lower concussion risk.

Since rule changes can only go so far in reducing the risk of impacts to the head, the scientists say that improving helmet design to lessen the damage that such trauma can do to the brain is also critical, and their data suggest that may be possible. No helmet can prevent 100% of concussions, but if some can reduce the risk, then they should be studied further, the researchers say.

TIME sleep

Sleep’s Best-Kept Secret: A Treatment for Insomnia That’s Not a Pill

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Why behavior therapy isn't used more, and what your smartphone can do about that

Do you toss and turn for hours before falling asleep? Or go to bed early but still wake up tired? Or keep waking up during the night? Then you’re among the more than 20% of people in the U.S. who suffer from a sleeping disorder like insomnia and your doctor is probably prescribing sleeping pills to help you doze through the night.

That’s despite the fact that the gold standard for treating sleep disturbances, recommended by the National Institutes of Health and the American Academy of Sleep Medicine, is Cognitive Behavioral Therapy for Insomnia (CBTI). CBTI, which focuses on changing behaviors that can contribute to poor sleep, has been shown to work long-term while sleeping medications tend to lose effectiveness after a few weeks (sleep medications may, however, be prescribed initially along with CBTI).

So why are pills the most common solution? Convenience, for one. Even if you’re willing to seek out a sleep experts who is qualified to give CBTI, you may not find one near you. Despite the epidemic of sleep disorders and their impact on health, there are only a few hundred sleep experts in the whole country.

MORE: A Sleeping Pill Without The Sleepy Head?

Doctors may also be unaware of the therapy. “I do not think many doctors know about CBTI,” says Rachel Manber, professor of psychiatry and behavorial sciences at Stanford University Medical Center. “Some provide sleep hygiene recommendations. However, like dental hygiene, sleep hygiene is best thought of as preventive rather than treatment.” These include sleeping in a dark room, sticking to regular bed times, and avoiding caffeine and exercise before bedtime.

If you did find your way to a sleep clinic expert, you would have an extensive interview about your medical history and sleep problems and fill out a detailed sleep diary for two weeks, then return for treatment. If that information points to a medical problem like sleep apnea, then you would have to spend at least one night sleeping in a lab, hooked up to a multitude of sensors that monitor your respiration, heart rate, and sleep level measured by an EEG . Then, after these recordings help to diagnose your sleep issues, you would start treatments with a therapist to develop habits that condition you to sleep better at bedtime and improve your quality of sleep, by helping you to turn down stressful thoughts and avoid things around you that interfere with good sleep.

Most CBTI treatments take four to six weeks to be fully effective, which helps to explain why it pales in comparison to the immediate, if not long-lasting, benefit of sleeping pills. But now, Israeli scientists have come up with a way to potentially streamline the therapy for some by bypassing the sleep lab and delivering the treatment via smartphone.

MORE: What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things)

SleepRate is an app that helps people who can’t or won’t go to a sleep clinic to generate, in DIY fashion, the same kind of information that all the monitors do to help sleep experts design the right behavioral therapy for patients. Anda Baharav, SleepRate’s founder and a former researcher at the Medical Physics Department at Tel Aviv University says this product can detect sleep disturbances by mathematically defining the connection between sleep, heart rate and respiration. They have combined their diagnostic method with a smartphone adaptation of a Stanford University proprietary CBTI treatment to bring CBTI to more people with sleep disorders. Anyone with an iPhone or certain other smartphones can download the app kit for $99, which comes with the sleep plan and a heart-rate monitor worn across the chest.

Here’s how it works. You sleep in your own bed for five nights with the chest belt and app on, and you also record how you feel subjectively about your sleep and alertness before you start the program, and then again every evening and morning for the five days of the assessment. The app keeps track of all the information in a sleep diary, and provides the results from the previous night’s sleep in an easy-to-read graphic. which the user can see and learn how long it takes to reach stable sleep, how many times you wake during the night, the sequence of your sleep stages throughout the night and how much quality sleep you get. Your phone’s microphone will also record noises around you and identify which ones wake you up. “If you’re used to living in New York City, for example,” Baharav says, “the traffic and sirens may not wake you, but your fridge banging on at 4 a.m. might.” So your sleep plan might include a service call from your appliance company—or a new fridge.

MORE: Less Sleep Linked To Alzheimer’s Disease

After the five-night assessment, you get a personalized sleep plan based on your particular sleep issues. The plan guides users about when to go to bed and when to wake up, suggests exercises to help them unwind and forget about the day’s worries, and even outlines how to spend buffer times, or the one to two hours before bed when it helps to do routine, unexciting things such as taking a bath, listening to music, or reading (but no thrillers). Based on the information you entered, for example, your smartphone screen will alert you about when to start your buffer time activity, with something like a cartoon of someone sitting quietly on a sofa with the instruction: Start Buffer Zone.

The suggestions are offered sequentially over four to six weeks to give you time to learn the new behaviors. If you don’t reach a goal, you try again, and when you achieve your goal, such as getting out of bed at the same time for several days in a row, the program provides a new target. You can also pull up your sleep data at any time to see patterns and trends. And the app reminds you what not to do as well: No! Don’t take a nap now.

While there are other such user-friendly CBTI kits available, Shelby Harris, director of the Behavioral Sleep Medicine Program, Sleep-Wake Disorders Center at Montefiore Medical Center in New York, says SleepRate is “more comprehensive since it also takes into account medical causes for insomnia.” Because there is a shortage of qualified CBTI practitioners, she sees such apps as viable and welcome first-line efforts for helping people with insomnia. If the programs don’t help, she says, then patients can see a sleep specialist.

And what about people who don’t have a diagnosable sleep disorder but are simply sleep deprived? Could such a program, for example, help parents of babies and young children to find more good quality sleep? Baharav says that’s coming soon. Stay tuned.

TIME public health

Bird Flu Isn’t Just China’s Problem Anymore

A security guard closes the gate of a live poultry market in Cheung Sha Wan before officials proceed to cull chickens in Hong Kong on Jan. 28, 2014. Philippe Lopez / AFP / Getty Images

With the Chinese New Year and the Olympics on the horizon, health officials can only watch and wait for a potential pandemic

As the first human cases of H7N9 bird flu infection outside of China begin to emerge—in Taiwan and Hong Kong—health officials around the world are preparing for a potentially perfect storm for a massive flu outbreak. On Thursday, billions of Chinese will be on the move to celebrate the Lunar New Year, creating ripe conditions for the spread of the influenza virus from those already infected. And many of those celebrations will include chickens, the primary carriers of H7N9. In addition, with the Winter Olympics, one of the world’s largest sporting events, just two weeks away, the virus could find the ideal conditions for breaking out.

And that means the next plane could bring a pandemic to the U.S. or anywhere else around the world. “The bottom line is the health security of the U.S. is only as strong as the health security of every country around the world,” says Dr. Thomas Frieden, director of the U.S. Centers for Disease Control. “We are all connected by the food we eat, the water the drink and the air we breathe.”

MORE: Many Americans Are Skipping the Flu Shot

So far, the World Health Organization reports that 246 people, mostly in China, have been infected with H7N9 since the virus was first identified last year, and nearly a quarter of them have died. As the first cases outside of the China emerged, Hong Kong officials ordered the culling of 20,000 chickens from its primary poultry market after one bird tested positive for H7N9, and banned live poultry imports for three weeks from the mainland. In the meantime the Chinese government is shutting down live poultry sales in its eastern provinces after a spike in cases in recent weeks. Because H7N9 does not make birds sick, it’s nearly impossible to distinguish infected poultry from healthy animals, so officials aren’t taking any chances. Shanghai is closing its live poultry markets for three months beginning in February.

What concerns health experts is that H7N9 meets two of the three conditions for becoming a pandemic—it is widespread among birds, and it can pass from birds to people. So far, it does not appear to transmit easily from person to person, but if it did, says Frieden, “that would be a big problem. The likelihood of having a pandemic would be much, much higher.”

MORE: Should You Be Chicken About the New Chicken Flu?

What could push the virus to move from person to person? One worrying possibility—as H7N9 circulates among birds, it could recombine with other influenza strains and find a way to infect humans more efficiently by jumping from host to host. It’s also possible that the H7N9 infecting people could recombine with other strains currently circulating, such as H1N1 or even H5N1, another bird flu, and become more virulent as well. Vietnam confirmed that a 52-year old man died this week of H5N1.

If H7N9 were to become a pandemic, there is a vaccine that researchers have developed, but Frieden says it’s not very effective and may require more than one dose, which could complicate distribution if there were an urgent need to immunize the population. But other measures for containing outbreaks that have proven effective in the past, including reducing the contact between people and infected animals, implementing social distancing strategies to prevent rapid spread of the virus, and dispensing medications to treat the severely ill, could help to contain an outbreak. “Flu reminds us that we are all connected by the air we breathe,” says Frieden. “There is no way for us to know if a pandemic will happen tomorrow or 10 years from now or never. But what we can do is be even better prepared than we have in the past if it happens.”

TIME hospitals

Hospitals Struggle With IV Saline Shortage

Anesthesiologist in operating room. Dana Neely / Getty Images

FDA is working with manufacturers to maintain the supply

The U.S. Food and Drug Administration (FDA) warned hospitals and health care workers of a national shortage of intravenous (IV) saline solution, and urged doctors to conserve existing supplies. The agency is working with three manufacturers to address problem and provide alternatives if needed.

Millions of bags of the solution, which are essential for hydrating patients, and are also critical for cleansing the blood of dialysis patients, are used nationwide each week. The Washington Post reports that manufacturers told the FDA last year that they were expecting delays in filling hospitals’ orders after some plant shutdowns for routine inspection and upgrades. The IV solution cannot be replaced with other forms of saline because it is specifically designed to be administered by injection; in a letter to health care providers, the American Society of Health-System Pharmacists warned that saline solutions used for irrigation are “not approved for injection because it may have higher levels of particulates.”

MORE: Inside America’s Drug Shortage

The FDA says the shortage was triggered by several factors, including delays in delivery and increased demand by hospitals to treat flu patients.

Some healthcare providers are asking staff to find ways to conserve the IV solutions by using smaller bags, while others are using alternatives such as oral hydration fluids. Valerie Jensen, an associate director of the drug shortages program at the FDA told The Washington Post that no hospitals have actually run out of saline, they are “still reporting that they may only have a few days supply.” The agency is hoping the three major manufacturers of the product — Baxter Healthcare Corp., B.Braun Medical Inc., and Hospira Inc. — will be able to meet the increased demand in coming weeks.

[The Washington Post]

TIME Stem Cells

Growing Your Own Tissue: Just Add Stress and Stir

Stem cells division, computer artwork Getty Images / Brand X

Researchers report on an exciting new way to reprogram cells so patients might one day grown their own cells to replace diseased ones

It took seven days for Haruko Obokata and her team to learn that they might have rewritten the rules of biology. Working with a bunch of blood cells obtained from newborn mouse spleens, the group found that physical stress —in the form of acidic conditions, or the tight squeeze through a pipette—could turn developed cells back to their embryonic state.

In recent years, such embryonic stem cells, which have the capacity to morph into any of the body’s cells, have become a hot area of research. If doctors can find a reliable way of generating them, they could potentially recreate any tissues, or organs, for that matter, that need replacing if they become diseased. Dead heart tissue starved of oxygen after a heart attack could be replaced, and ailing pancreas cells that no longer produce enough insulin might help diabetic patients.

So far, however, there are only two ways to obtain embryonic stem cells—both of which involve introducing new genetic material to cells. In one, a cloning method known as nuclear transfer, DNA from a mature, developed cell, is inserted into an empty egg cell and electrically and chemically coddled until it starts dividing and producing stem cells. In 2006, Japanese researcher Shinya Yamanaka improved on this method by mixing adult mouse cells with certain genetic factors that produced the same result—embryonic-like stem cells that had erased their developmental history and were reprogrammed back to the time when they could become any cell in the body (he repeated the procedure with human cells the following year and earned the Nobel Prize in 2012).

MORE: Stem Cells Could Lead to Better Breasts After Reconstructive Surgery

But Obokata and her team eliminated the need for any genetic manipulation at all. In their experiment, reported in the journal Nature, all it took was a bath of acidic, low pH solution to turn back the clock on the mouse blood cells. “It was really surprising to see such a remarkable transformation triggered simply by stimuli from outside the cell,” Obokata said during a press briefing.

Plant cells can do it, as a survival mechanism; during periods of drought, for example, carrot cells can reprogram themselves to generate entirely new plants when conditions improved. But Obokata is the first to demonstrate the process in animals.

MORE: Stem-Cell Research: The Quest Resumes

To prove that the cells were indeed reprogrammed, and not simply already embryonic, the scientists measured levels of marker proteins that signal pluripotency, or a cell’s ability to turn into a multitude of different cell types. None of the blood cells expressed these markers before they were exposed to the acidic medium. And to show that the reprogrammed cells were indeed able to generate any of the body’s cells, they injected them into early embryos and found that the resulting mice were chimeric, meaning they possessed a mixture of their original and the reprogrammed cells.

“It’s remarkable that something so simple could do this,” says Austin Smith, director of the Wellcome Trust-MRC Stem Cell Institute at the University of Cambridge. “But it seems a bit dangerous.”

Why, for example, did the low pH not prompt the cells to form tumors instead? And why doesn’t this reprogramming occur in the body, when similar conditions are met—such as, for example, in the stomach, which is highly acidic? “I guess our tissues have some inhibitory mechanism to inhibit reprogramming,” Obokata said. “But to prove that we need further studies.”

MORE: Scientists Report First Success in Cloning Human Stem Cells

First among them would be tests of human cells, to see if what occurred in the mice is also possible in humans. That could open the door to considering this process as a way to generate cells that patients might eventually use to treat diseases such as Alzheimer’s, heart conditions and spinal cord injuries. Already, the first trials of using embryonic stem cells, made from the nuclear transfer technique, are underway in the U.S. to treat macular degeneration.

There are limitations to the technology. Obokata says the efficiency of producing them from acidic conditions is relatively low, at 6% to 7%. And it’s not clear that the cells, which Obokata dubbed STAP cells, for stimulus-triggered acquisition of pluripotency, can be produced by every tissue in the body. She and her team tested brain, skin, muscle, fat, bone marrow, lung and liver tissues from mice and all produced STAP cells, although Smith points out that these represent only three different cell types.

MORE: Early Success in a Human Embryonic Stem Cell Trial to Treat Blindness

She and her group also used cells from week-old mice, meaning they were still relatively young, despite being fully developed into blood cells. Obokata has done preliminary work with some older mouse cells, and said that “the reprogramming efficiency decreases along with age.” But she is hoping to modify and improve on the technology to make STAP cells as efficient to make from older cells as they are from younger ones.

More follow up research on the fate of the cells is also critical, to see if they tend to generate tumors later. But it’s an exciting step that could lay the foundation for a new age in regenerative medicine, when scientists might have their pick of several reprogramming techniques that could help them to match the best method to the right patients to treat their disease.

TIME Heart Disease

Why It’s More Deadly to Get Sick at Night Or On Weekends

Warning signs of a heart attack Getty Images / Vetta

New research from Mayo Clinic experts shows that you’re more likely to die of a heart attack at night or on the weekend.

The scientists reviewed nearly 50 studies involving 1,896,859 patients that showed that being treated at the hospital for a heart attack during off-hours, such as nights and weekends, was associated with a 5% greater risk of dying–both in the hospital and after discharge–than being treated during regular hours.

For patients with a severe form of heart attack, called ST elevation myocardial infarction (STEMI), off-hour treatment resulted in delays of about 15 minutes, which increased the risk of death by about 10% to 15%. The researchers suspect that the skeleton staff, and not having specialists on hand in the hospital, are the main reasons for the higher death rates.

It’s not the first study to highlight the problem, and the connection between when patients get treated and health outcomes has recently received more attention, since they reveal areas in which hospitals can improve on the care they deliver. Another study from May 2013 involving one million hospital admissions for heart failure over a 14 year period found that patients who were admitted to hospitals for heart failure in January, on a Friday or at night, spent more time in the hospital on average, and had a higher risk of dying from the condition. Other studies found that patients treated in July had higher death rates and complications than those treated in other months, since the most experienced residents graduate in June and the newest crop of residents — last year’s medical students — step in to care for their first patients.

What are hospitals doing anything to address the disparity? “We know that hospitals have fewer staff and resources over nights and weekends which all health professionals know about,” says study author Dr. Atsushi Sorita, a senior fellow in preventive medicine at Mayo Clinic. “There may be an opportunity to design the system to provide consistent quality of care.”

(MORE:The Worst Times to Be Treated for a Heart Condition)

But simply adding staff may not be the answer. Mayo Clinic in Rochester, Minn. was not one of the hospitals included in the study, but Sorita says it has a 24/7 program in place to treat heart emergencies, with specialists and well-trained nurses available any time of day or night. Has it made a difference? Sorita says the round-the-clock heart failure care has been in place since around 2008, but there are still fewer staff members and resources over the nights and weekends. “We can’t conclude from this study [if adding a full staff will have an impact], but increasing staff would add costs to the hospital, and how much value can we add? We can’t conclude from our study,” he says.

Dr. Gregg Fonarow, the co-director of the UCLA Preventative Cardiology Program and an American Heart Association spokesperson, says healthcare providers should be paying more attention to how much and what type of staffing is enough to address the mortality differences. “Providers should continue to work to enhance the healthcare system during regular and off-hours and to reduce existing disparities in cardiac care,” he says in an email to TIME.

MORE: The July Effect: Why Summer is the Most Dangerous Time to Go to the Hospital

For example, the American Heart Association’s Get With The Guidelines Quality Improvement Program–which was designed to improve in-hospital care based on the latest research–has helped to equalize health outcomes for patients cared for during and outside of normal hours. That program offers doctors access to research studies, professional workshops and webinars on best practices that can improve their patients’ outcomes, as well as education materials for patients to help them make quick recoveries. “[This illustrates] that performance improvement systems can bridge this gap in care and outcomes for acute myocardial infarction patients presenting during off-hours,” Fonarow says in his email.

The latest study isn’t a message that people who need emergency heart treatments avoid the hospital if it’s at night or on a weekend. It’s a wake up call to administrators that there are serious discrepancies in health outcomes that are within their control to eliminate — by making sure that the care provided is of the highest quality no matter what the day or time of day.

TIME medicine

We Need To Take Meditation More Seriously As Medicine

a young woman meditating
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Deep breathing and yoga previously haven't been taken seriously as healing cures, but a new medical study found tangible benefits to the practice of meditation, leading to fewer sick days and reduced anxiety. So why aren't doctors prescribing it?

To be fair, I’m not sure how I would have responded had my surgeon suggested I meditate before or after surgery to ease my anxiety or post-operative pain. My guess is, like many women, I would have been skeptical: what exactly did sitting in half-lotus pose or breathing deeply have to do with the tumor in my right breast? And why was a doctor—whose job and training and every measure of success is rooted in science and clinical outcomes—prescribing a spiritual or religious method of therapy?

But a new review study, published last week in the Journal of the American Medical Association (JAMA) Internal Medicine, suggests that the ancient Eastern practice of mindful meditation can offer real help for patients with depression, anxiety, and pain. And researchers are increasingly demonstrating the measurable influence of meditation on the brain, proving that mindfulness programs can make us feel happier, have greater emotional resilience and take fewer sick days.

(MORE: The 20 Minute Morning Routine Guaranteed to Make Your Day Excellent)

The problem? Many of us conflate meditation with yoga or other types of complimentary medicine, overestimate the time it takes to meditate effectively, and discount the neurological evidence that mindful focus improves brain functioning.

Dr. Madhav Goyal is a professor of medicine at Johns Hopkins, whose research focuses on the effects of meditation on chronic pain and stress, as well as low-cost means to improve health in rural India. As the lead author of the recent JAMA study, he reviewed 47 clinical trials involving more than 3500 participants with mild anxiety or depression, and found that those who practiced mindful mediation saw a 5-10% improvement in anxiety symptoms and a 10-20% reduction in depressive symptoms compared to placebo groups—on par with the effects other studies have shown for anti-depressants in similar populations.

Critics of the study basically argue that the 5-10% and 10-20% outcomes are insignificant, though they are willing to concede that doctors should consider “limited term mindfulness programs” in lieu of “pharmacological intervention” in some cases of anxiety and depression.

But what’s most striking about the JAMA findings is that people weren’t meditating for very long. Many in the underlying studies meditated for as little as 2.5 hours per week for two months. As Dr. Goyal points out, because meditation is a skill that’s learned over time, it’s unlikely the respondents reached a high level of expertise. So according to him, it’s plausible to think that people would experience even greater benefits with more rigorous training and practice.

Unfortunately though, it’s precisely those realities of meditation— that it is a state you can teach yourself to achieve and improve with discipline— that might undermine its validity with physicians and patients. For example, professor Mark K. Blum, a Buddhist Studies expert at the University of California, Berkeley, believes some medical professionals may doubt the value of meditation because our culture has shifted so heavily in favor of quantitative measurement. As Ben McAllister writes for The Atlantic, we’ve become a society addicted to data; problem is, some things are easier to measure than others.

“Medical doctors are practicing a form of science, and therefore expect to see scientific measurement,” Blum explains. “But how do you measure meditation?”

Berkeley is hosting a conference this spring to examine the question, Buddhism, Mind, and Cognitive Science, and to see if the complex relationship between meditative culture and Buddhism can be compatible with the “neurophysicalism” underlying scientific research.

In Dr. Goyal’s view, critics of complimentary or alternative medical research have a misunderstanding of what science is. It has nothing to do with molecules or drugs, he says Rather, medical science is a “systematic exploration of what is not known,” whatever that may be— and areas like meditation desperately need more exploration, and the funding to do it.

(MORE: Aaron Alexis and the Dark Side of Meditation)

Shanida Nataraja, a London neurophysiologist and author of The Blissful Brain: Neuroscience and Proof of the Power of Meditation, explained that because there are many different types of meditation, what it actually means to meditate can differ from person to person. That lack of uniformity may be quite problematic for a medical community with established guidelines and review boards. But just because it’s hard to imagine one doctor telling you to use a candle as a meditation anchor, and another advocating a mantra-based approach, it’s not reason alone to dismiss the potential health benefits.

Jacoba Urist is a contributing health and lifestyle reporter for NBCNews, who also writes for The Atlantic. She received her JD from New York University School of Law and her MA from the Johns Hopkins Institute for Health and Social Policy.

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