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.

MORE: Eat Better and Stress Less: It’ll Make Your Cells (and Maybe You) Live Longer

TIME Obamacare

Hate Obama, Love Obamacare

When Sean Recchi was diagnosed with cancer, he and his wife Stephanie were billed $83,900 by the hospital, in advance. Now he has insurance. Claudia Susana for TIME

How a skeptical Ohio family found plenty to like in health care reform

I don’t think Obamacare will help us. I don’t want anything to do with it,” Stephanie Recchi told me a week after the launch of HealthCare.gov on Oct. 1. “I hear a lot of bad things about it–that it doesn’t cover pre-existing conditions and it’s too expensive,” she added, referring to what she said were “television ads and some politicians talking on the news. Just a lot of talk that this is a bad law.”

Recchi’s interest in health insurance is anything but casual. Those who read TIME’s special report in March on health care costs (“Bitter Pill: Why Medical Bills Are Killing Us“) may recall that when Stephanie’s husband Sean, then 42, was diagnosed with cancer a year earlier, the couple–who together were drawing about $3,500 a month from the small business they had just started in Lancaster, Ohio–had to borrow from her mother and max out their credit cards to try to save him.

MD Anderson Cancer Center in Houston had told Stephanie that their insurance (for which they paid $469 a month) was virtually worthless. So the hospital demanded $83,900, in advance, just to develop a treatment plan for Sean and cover his first $13,702 transfusion, along with simple items like gauze pads at $77 per box and routine lab tests for which he was billed tens of thousands of dollars.

As I reported, Stephanie recalled that her husband was “sweating and shaking with chills and pains. He had a large mass in his chest that was … growing. He was panicked.” Nonetheless, Sean was held in a reception area and kept from seeing a doctor for about 90 minutes until the hospital confirmed that the Recchis’ check had cleared.

All of which explains why despite the negative–and in this case, completely inaccurate–scuttlebutt she says she had heard about Obamacare, Stephanie Recchi visited HealthCare.gov repeatedly after it launched. But, she said, “I just never got anywhere … It kept freezing or crashing.”

That Obamacare crashed on Stephanie and Sean Recchi, of all people, amid a torrent of misinformation about what the law could or could not do for them, epitomizes the calamity of the failed launch. But what has happened to the Recchis and their health care options more recently might be emblematic of the law’s potential.

The key provisions of Obamacare seem as if they were drafted by someone sitting next to Sean Recchi in that MD Anderson holding room. Under the law, insurance companies can no longer turn away people with pre-existing conditions or even take those conditions into account when determining what people like the Recchis pay for their coverage. When Stephanie logged on in October, she was shopping for a family facing the ultimate pre-existing condition–cancer. Although Sean is now in remission, he is regularly seeing doctors in Ohio and taking drugs costing hundreds of dollars a month.

Stephanie, Sean and their two children are also a perfect match for the demographic that Obamacare was designed to serve: a family of four earning less than $40,000 a year, unable to get insurance from an employer because the Recchis had just started their own business.

Another feature of Obamacare is those much heralded online insurance exchanges, meant to enable those without job-related coverage to log on and find an array of competing products, none of which would be allowed to have the bait-and-switch limits that had left Sean unprotected when he needed lifesaving care. (When he was diagnosed with cancer, Sean’s policy limited his coverage to $2,000 a day in the hospital, which at MD Anderson barely covers an opening round of blood tests.) And all policies would be presented on the exchanges in plain English for easy comparison. Or, as President Obama often put it, buying health insurance would now be like going online to buy an airplane ticket.

Finally, people with incomes below 400% of the poverty line (up to about $94,000 for a family of four like the Recchis) would get subsidies from the government, so that it all would be more affordable. If they were at or below the poverty level, they would be enrolled in Medicaid for free.

The Recchis now know all that, and they’re fully insured for 2014. But it took a while. When we spoke in October and Stephanie told me she didn’t “think Obamacare will help us,” I suggested that she might be mistaken and that if she was unable to get information from the then sputtering website she should consult an insurance broker. (Insurers pay the brokers’ fees, not consumers.)

“When they came to my office, Stephanie told me right up front, ‘I don’t want any part of Obamacare,’ ” recalls health-insurance agent Barry Cohen. “These were clearly people who don’t like the President. So I kind of let that slide and just asked them for basic information and told them we would go on the Ohio exchange”–which is actually the Ohio section of the federal Obamacare exchange–”and show them what’s available.”

What Stephanie soon discovered, she told me in mid-November, “was a godsend.” The business that she and her husband had launched–which sells a product that enables consumers to store their DNA or that of family members for future genetic testing–had recently received investor interest after being featured on an episode of the television series CSI. So she estimated to Cohen that their income would be about $90,000 in 2014. But even at that level, her family of four would qualify for a subsidy under Obamacare.

The Recchis and their agent soon zeroed in on a plan with a $793 monthly premium that provided full coverage, though with a deductible of $12,000 for the entire family, meaning the Recchis would pay the first $12,000 in expenses. After the deductible was reached, there would be no co-payments for anything, including all drugs. However, the Obamacare subsidy, assuming a $90,000 income, brought their cost down to $566 a month. If their income was the same $40,000 Stephanie had estimated for 2013, the subsidy would increase and their premium would be just $17 a month.

“They had budgeted insurance at $1,200 for each of them for their new business,” says Cohen. “That’s $2,400 for the two of them, compared to $566, so they were thrilled … They had seen all those stories on television, and because of their views about Obama, they believed what they wanted to believe–until they saw these policies and these numbers.”

“Here I get full protection for $566, compared to no protection for almost $500,” Stephanie says, referring to her old plan that had cost $469 monthly and that MD Anderson had scoffed at. “This is wonderful.”

It ended up even better than that. Because Cohen could enter only the Recchis’ actual reported 2013 income onto the website, not their anticipated income when and if the investment deal is completed, and because that reportable income turned out to be significantly less than the $40,000 Stephanie had estimated, the website moved them automatically into Medicaid–meaning their coverage, for now, is free. That’s because Ohio Governor John Kasich decided to buck a majority of his fellow Republican governors and accept Obamacare’s subsidies so he could expand Medicaid coverage.

Kasich’s decision, however, illustrates one of three aspects of the Recchis’ story that throw cold water on this fairy-tale ending.

First, if Kasich had followed the lead of Obamacare resisters like Texas Governor Rick Perry, the Recchis would have been in the following through-the-looking-glass situation: If, as it turned out, their income was below the poverty level, they would have had to pay the full $793 for this insurance if they lived in Texas (but nothing in Ohio). But if their income was actually $90,000, they would pay only $566. That’s because the law as written required all states to accept the government’s subsidy for Medicaid to be extended to everyone with incomes below the poverty level. As a result, no premium subsidies in the exchange plans were provided for people below the poverty level, because they would presumably go into Medicaid. But in June 2012, the Supreme Court ruled that the states’ expansion of Medicaid had to be voluntary. That left the poor in states such as Texas or Florida that did not expand Medicaid faced with having to pay more than those who are not poor. Unlike the middle class, they could buy only health insurance without subsidies, because they were supposed to have been sent into Medicaid.

Here’s the second asterisk to the Recchis’ happy ending: even once the website was fixed, Sean and Stephanie still needed help from Cohen, their insurance agent, to make sense of it all. Buying health insurance is exponentially more complicated than buying a plane ticket. The exchanges have “bronze,” “silver,” “gold” and “platinum” levels of coverage, each featuring multiple variations of premiums, co-pays, co-insurance and deductibles. There are also the hard-to-find and harder-to-understand lists of which hospitals and doctors are in the insurance company’s networks. And those lists are models of clarity compared with the lists of drugs that are covered by each plan.

“There is no way the Recchis or anyone else can figure out what they’re buying without someone who has been trained sitting with them,” says Cohen. Sure, that’s a self-serving assessment, but in interviews across the country with people who have signed up for Obamacare (and from my own experience), I found no one who fully understood the benefits, the costs or, most important, the limits of what they were buying unless they were helped by agents or by “navigators”–enrollment assistants trained and certified by officials operating the exchanges.

Understanding the limits of what consumers are buying puts another damper on the Recchis’ story: their insurance–whether Medicaid for now or the plan they are likely to transition to later this year–is not going to cover them at MD Anderson in Houston. No Ohio plan will. In fact, only two of 79 plans offered in Texas on its federally run Obamacare exchange include coverage at MD Anderson.

MD Anderson is extravagantly expensive. With its well-deserved international brand name, it has more than enough business without letting insurance companies negotiate for discounts in exchange for being included in their networks.

More generally, one of the ways insurance companies have tried to limit their costs and the premiums they are charging on the Obama exchanges is to have relatively narrow networks that are limited to the hospitals, doctors and other providers who offer the companies relatively cost-effective prices. Because there is frequently little or no relationship between cost and quality in the dysfunctional world of health care economics, this does not necessarily mean patients will receive inferior care, though it might. But it does mean that, contrary to a promise Obama made in promoting Obamacare, patients will often not be able to be treated by the doctor they want or at the hospital they want.

As with his vow that Americans could keep their insurance if they liked it, this is a promise the President should not have made. He can’t control insurance companies’ decisions about their networks, nor should he want to. Costs might come down and quality might go up when insurance companies can make hospitals and doctors compete on quality and price to be in their networks.

In other words, expanding coverage to people like the Recchis while trying to control premium costs is going to mean that not everyone gets the platinum care they want and that others will. When it comes to health care, as opposed to buying a car, that’s difficult for anyone to accept. “No, we don’t get MD Anderson, but we do get the Cleveland Clinic and lots of other good care,” Stephanie says. “We understand that.” Amid the likely attacks from his opponents that he’s taking away patients’ favorite doctors and hospitals, Obama has to hope that others come to share her attitude.

TIME public health

The Secret Life Of Bed Bugs: Study Reveals Seasonal Trends in Growth

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Bed bug infestations are a nightmare for homeowners. And residents of Philadelphia are familiar with the pain, since reports of infestations in the city have increased over the years.

A team of Penn Medicine researchers are conducting a major study with the goal of coming up with cheap and more effective ways to get rid of the pests. Part of their findings — which identified the seasonality of the little critters — was published in the Journal of Medical Entomology.

Surprisingly, there’s little known about what seasons breed the most bed bugs, so the scientists looked at four years (2008-2012) worth of bed bug reports in Philadelphia and mapped out the location of each call. From 2008 to 2011, the reports increased 4.5% every month, which is nearly a 70% increase year to year. They found that infestations peaked in August and were at their lowest in February. This means that perhaps the bugs circulated and reproduced more in warmer months.

Bed bugs typically cannot move very far, and if pushed out by eradication efforts, usually crawl into another room or from one home to a neighboring one. But the researchers speculate that they are moving more quickly and traveling further distances by riding on people or their accessories to other venues.

Knowing when to expect more infestations is an important step to developing new and more effective eradication methods, including whether such campaigns are more productive during the preseason, or at the height of an infestation. And that can only be welcome news.

TIME brain injury

A New Blood Test to Diagnose Concussions On The Field

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A protein could signal the first signs of brain changes due to a concussion.

With a finger-stick and a drop of blood, researchers from the University of Rochester say it may be possible to tell whether a player experienced a concussion.

Levels of the brain protein S100B start to rise with intense exertion, but also after a major impact such as a blow to the head. So the scientists investigated whether it would be possible to distinguish the two circumstances in hopes of finding a way to detect the first signs of traumatic brain injury.

They tested 46 athletes over age 18 for baseline levels of S100B during their preseason. After physical exertion, the researchers tested them again and found that their S100B levels rose slightly, by an average of 2%. During the season, 22 of the athletes had a clinically diagnosed concussion. Seventeen of the athletes with confirmed concussions had a S100B blood test done within three hours of the injury and their levels were 81% higher than baseline.

Based on their findings, the researchers concluded that a rise in S100B of more than 45% is nearly equivalent to a concussion diagnosis, and easily distinguishable from physical exertion.

In Europe, researchers are using the protein test to study which patients with brain injuries may be at risk for internal bleeding and should have a CT scan. The group hopes to get the blood test approved for concussion diagnosis in the U.S., but acknowledge that more studies will be needed to confirm their results first. They note, for example, that more players from different sports should be tested, and that scientists should investigate how the protein levels may vary among men and women. Still, the findings, published in the journal PLOS ONE, suggest that it may be possible, on the field of play, to identify which players who have experienced head traumas need closer monitoring and treatment for concussion, which could reduce their chances of more permanent and lasting damage.

TIME medicine

Brain Death Really Is Death

Jahi McMath
Jahi McMath Courtesy of McMath Family and Omari Sealey / AP

Concepts matter in medicine. This could not be more obvious than in the utter confusion on display over the concepts of ‘brain death’ and ‘life support technology’ that has resulted in two dead bodies being kept on ventilator support in California and Texas.

In Oakland, California 13-year old Jahi McMath has been maintained on machines since an elective procedure to treat her sleep apnea went horribly wrong on December 9th. She has been in the ICU on a ventilator at the Oakland Children’s Hospital since then.

(MORE: Teen Girl Brain Dead After Tonsil Removal Goes Wrong)

In Forth Worth, Texas, Marlese Munoz has been on machine support in the ICU at John Peter Smith Hospital since, without any warning last November 26th, she suffered a pulmonary embolism. She was then 14 weeks pregnant.

In both cases Jahi and Marlese have been declared brain dead. In both cases there is a huge controversy over whether their ‘life-support’ can be stopped. In both cases a misunderstanding of these terms have led to outcomes that make no ethical sense at all.

Jahi’s parents do not want the machines to be disconnected from her body. They are praying for a miracle. A judge has ordered life-support be continued at least until January 7th.

(MORE: Life Support Extended for ‘Brain-Dead’ Girl)

In Marlene’s case, her husband and family want the machines stopped. But the hospital refuses citing a Texas law that says, “A person may not withdraw or withhold life-sustaining treatment … from a pregnant patient.”

What is incredible about both cases is that neither the parents of Jahi McMath nor the state of Texas should have any say whatsoever in stopping the discontinuation of life-supporting technology when someone has died.

Brain death is death. It has nothing to do with being a coma. It does not refer to a permanent vegetative state. It does not refer to being severely brain damaged. Comatose (unconscious) patients recover all the time. In fact, physicians often use medications to temporarily place a patient into a coma to aid in recovery. Vegetative patients have lost (temporarily or permanently) most of their higher brain functions. Recovery is more rare in these cases, but a lot depends upon the amount and type of injury that has been done to the brain. These patients, such as Terri Schiavo, are still alive, whether they recover from their brain injuries or not.

(MORE: Terri Schiavo’s Family Urges Life Support For Brain Dead Teen)

Jahi and Marlese are not injured or comatose or vegetative. They are deceased. They have been pronounced dead by multiple physicians who have conducted standard tests and diagnostic procedures. When a person is dead there is no longer any possibility of ‘life support’ by any technology or machine. When a person is dead there is nowhere to transfer them to recover. When a person is dead, life support has to end since regardless of what parents, judges or legislators might want to believe, no physician can do anything to treat death.

When doctors say ‘brain dead’ instead of dead they confuse family members, the media, judges and the public. Calling someone brain dead makes it sound like they are almost dead, sort of dead, kind of dead but not really dead—which they are.

When doctors or others talk about stopping ‘life-support’ on a brain dead person they make it sound like they are ending care for a living person. But in removing life-supporting machines from the brain dead doctors are simply engaged in one of the last mandatory acts they must perform when someone has died.

Both California and Texas state law realize the reality of what brain death is and what it means. Both states permit the cessation of all treatments for the dead. Both states indemnify doctors against any penalties for doing so when death has been properly diagnosed.

(MORE: ‘Clinically Dead’? How Many Kinds of Dead Are There?)

Doctors and hospitals commonly give families a little time to say good-bye to the deceased patient before discontinuing ventilators. In California, this is required by law. It is important to recognize that this is not for the good of the patient since the patient has passed away. It is for the good of the family. But saying good-bye and beginning the grieving process cannot happen for either of these families until there is a recognition of the reality of death. Our technology makes it possible for the deceased to appear “life like.” It does not change the facts.

There is no reason for the doctors or administrators at the Children’s Hospital in Oakland to have listened to Jahi’s parents once, tragically, they determined that she had died. There is no reason JPS Hospital in Fort Worth should not immediately honor Marlene’s husband’s and family’s wishes and disconnect all treatment and technology. The fact that both are still on life-supporting technology is disrespectful to them. It is also inexcusably confusing to all the rest of us who may also one day have to face the reality of the limits of medicine when a loved-one dies while on life-support.

David Magnus PhD is the Director of Stanford’s Center for Biomedical Ethics.

MORE: Viewpoint: Why Brain Death Isn’t An On-Off Switch

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