TIME diabetes

How Race Affects Diabetes Care—and Leads to Amputations

High Blood Sugar Test
Getty Images

Black diabetics are much more likely to face amputation

Black type-2 diabetes patients are three times more likely to lose a leg to amputation as non-black patients, finds a new report from the Dartmouth Atlas Project. That’s partly because they’re also far less likely to get preventative care like foot exams, cholesterol testing and blood sugar testing.

Researchers looked at Medicare claims from 2007-2011 from patients diagnosed with diabetes and peripheral arterial disease, a condition in which plaque builds up in the arteries and blocks blood flow, primarily in the legs. They found significant disparities, both racial and regional: black patients and the rural Southeast region of the U.S. both saw elevated amputation rates.

Diabetes-related amputation, a last resort, generally results from wounds on the feet and poor circulation. Foot exams and testing for blood sugar and cholesterol levels can help lower the risk of having to resort to extreme measures. But in 2010, 75% of diagnosed black diabetics received a a blood lipids test, while 82% of non-black patients had the test.

An average of 2.4 leg amputations for every 1,000 Medicare patients with diabetes and peripheral arterial disease happen nationally, but regionally, the situation is much more grim. Mississippi, which currently ties West Virginia for the most obese state, also has some of the highest amputation rates—6.2 per 1,000 patients in the city of Tupelo. It’s not just racial: For every 1,000 black Medicare beneficiaries with diabetes, 14.2 amputations occurred in the Mississippi city of Meridian, but only 2.1 occurred among black patients in San Diego.

“The resources needed to prevent amputation are currently severely misaligned,” says co-author Philip Goodney, MD, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center. “While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain.”

TIME Innovation

Five Best Ideas of the Day: October 8

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

1. Quotas can cause lasting change. Rwanda’s new parliament is more than 60% female.

By Eleanor Whitehead in This Is Africa

2. With open communication and smart procedures, we can contain Ebola.

By Atul Gawande in The New Yorker

3. A simple plan to begin saving for college at kindergarten helps families thrive.

By Andrea Levere in the New York Times

4. Teach For America is sewing seeds for education reform in unlikely places – by design.

By Jackie Mader in Next City

5. How Bitcoin could save journalism and the arts.

By Walter Isaacson in Time

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.

MONEY

3 Awesome Cruise Deals to Book in October

October is a smart time to book a river cruise, as companies scramble to fill 2014 sailings and get a jump on next year. Here are three destinations offering terrific deals.

  • 1. The Mississippi

    Courtesy of American Queen Steam

    You don’t have to leave the U.S. to cruise. Popular domestic destinations include the rivers of the Pacific Northwest and the mighty Mississippi, says Mark Murphy of TravelPulse.com. Book by Oct. 31 for half off December sailings from New Orleans to Vicksburg, Miss., and back with American Queen Steamboat Co. The firm has two eight-day options for $1,275 a person (down from $2,550). Stops include the Oak Valley Plantation in Louisiana and the Old Natchez Trace trail in Mississippi. Onboard, dine in one of two restaurants and watch the river from the deck-mounted swing.

  • 2. The Rhine

    Courtesy of AmaWaterways

    You’ll find holiday deals on this Western European river. AmaWaterways is offering up to 40% off cruises from Basel to Amsterdam in November and December. The 13-day trip starts in Zurich, then heads up the Rhine, stopping along the way so you can tour local Christmas markets and sip mulled wine in cities like Cologne, Germany, and Strasbourg, France. The trip, typically $2,800 a person, drops as low as $1,680 if you book before Oct. 15. Prefer to wait for warmer weather? Snag a balcony room on more than 90 AmaWaterways 2015 sailings by the end of the month and get up to $1,500 off.

  • The Mekong

    AAA-10244001761
    Courtesy of Viking River Cruises—B SCHMIDa collection

    This 2,700-mile river runs through Vietnam and Cambodia, passing lush farmlands as well as metropolises like Ho Chi Minh City. A 15-day trip with Viking River Cruises is a great way to explore the area, says Ruth Turpin of Cruises, Etc.  You’ll explore the temple of Angkor Wat, see dance performances in Phnom Penh, and take a culinary tour of the floating markets of Cái Bè. Viking recently slashed its 2015 prices; this cruise, which launches multiple times each month, is now $3,500 (regularly $7,000) when booked before Oct. 31, and includes intracountry airfare and hotels.

  • Don’t Get Caught Short by Extra Costs

    While river cruises are often billed as “inclusive,” you will need to shell out for some expenses. Here are the big ones.

    Getting Aboard
    Budget for flights to and from your cruise, as well as for lodging the night before you depart (you don’t want to miss the ship!) and transportation from your hotel to the boat, says Adventure Life Journey’s Mary Curry.

    Extra Drinks
    Before you imbibe, read the fine print: Rates often include beer and wine with lunch and dinner, but you’ll usually pay extra for premium liquors or any drinks outside of mealtimes, says Scott Kertes of Hartford Holidays.

    All Tips
    Gratuities for staff and guides aren’t usually included, though there are exceptions, such as trips with Tauck. Not sure how much to give? “Budget about $100 per person per week,” says Murphy of TravelPulse.com.

TIME justice

Deadly Butt Injection Lands Mississippi Woman Life Sentence

Tracey Lynn Garner
This Wednesday, Aug. 27, 2014 file photo shows Tracey Lynn Garner during her trial in Jackson, Miss. Rogelio V. Solis—AP

Tracey Lynn Garner was convicted of murder over the fatal silicone injection

The Jackson, Mississippi, woman who administered an unlicensed silicone buttox injection that killed another woman was sentenced Tuesday to life in prison.

Tracey Lynn Garner, 54, was convicted last week of depraved-heart murder, a legal designation that signifies disregard for human life, for the 2012 silicone injection she gave to Karima Gordon, 37. Gordon fell ill immediately after the injection and died days later. Prosecutors argued that Garner was motivated by greed, Reuters reports.

Garner, who is transgender, was previously known by the name Morris Garner.

An investigator testified during the trial that he found a bottle of silicone and syringes labeled “veterinary use only” in Garner’s home.

[Reuters]

TIME abortion

Alabama Judge Rules Abortion Clinic Law Unconstitutional

Just a few days after a court in Mississippi struck down a similar law

An Alabama judge ruled Monday that a law requiring doctors who perform abortions in the state’s five clinics to have admitting privileges at local hospitals is unconstitutional, as it imposes an “impermissible undue burden” that amounts to total prohibition of abortions.

“The evidence compellingly demonstrates that the requirement would have the striking result of closing three of Alabama’s five abortion clinics,” U.S. District Court Judge Myron Thompson wrote in his decision. “Indeed, the court is convinced that, if this requirement would not, in the face of all the evidence in the record, constitute an impermissible undue burden, then almost no regulation, short of those imposing an outright prohibition on abortion, would.”

Supporters of the law, called the “Women’s Health and Safety Act” in Alabama, say abortion doctors need to have admitting privileges at local hospitals in case a patient has medical complications after an abortion. “By striking down the Alabama law that required abortionists to have admitting privileges to nearby hospitals, U.S. District Court Judge Myron Thompson is propping up incompetent, dangerous abortionists at the expense of the health and safety of the women in Alabama,” Kristan Hawkins, president of Students for Life of America, said in a statement. “It is a basic necessity to ensure the safety of women who are seeking abortions and to make sure their doctors are following standard medical procedures. To do anything otherwise would be to the detriment of women in the state.”

But the judge agreed with the plaintiffs, who were represented by lawyers for Planned Parenthood and the ACLU, that these laws have no basis in medicine—they’re opposed by the American Medical Association and the American College of Obstetricians and Gynecologists—and make obtaining an abortion unnecessarily difficult. “This ruling will ensure that women in Alabama have access to safe, legal abortion,” Planned Parenthood president Cecile Richards said in a statement. “And Planned Parenthood will continue to fight for our patients, because a woman’s ability to make personal medical decisions should not depend on where she lives.”

The 5th Circuit of Appeals struck down a similar law in Mississippi last week. “Pre-viability, a woman has the constitutional right to end her pregnancy by abortion,” Judge E. Grady Jolly wrote in his ruling, adding that the law requiring doctors to have admitting privileges “effectively extinguishes that right within Mississippi’s borders.” That court could only declare the law unconstitutional as it applies to Jackson Women’s Health Organization, the last remaining abortion clinic in Mississippi, and could not strike down the entire law, because it had been upheld by a 5th Circuit court in Texas.

 

TIME corruption

America’s Most Corrupt State Is Standing Up for Itself

LSU v Mississippi
Detailed view of the exterior of Vaught-Hemingway Stadium on the Ole Miss campus. Stacy Revere—Getty Images

Officials argue a recent report doesn’t take into account recent anti-corruption efforts

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This post is in partnership with Fortune, which offers the latest business and finance news. Read the article below originally published at Fortune.com.

The entire world must contend with corruption. It costs honest citizens thousands of dollars per year and saps trust in public and private institutions.

We’ve all experienced corruption on at least a small scale at some point in our lives, but actually measuring it is difficult. Recently, Fortune covered a study by two public policy researchers—Cheol Liu of the City University of Hong Kong and John L. Mikesell of Indiana University—who looked the rate at which public employees in each of the 50 U.S. states had been convicted on federal corruption charges from 1976 to 2008 to determine which state was the most corrupt in the union.

Their conclusion? Mississippi, The Hospitality State, has not been all that hospitable to its citizens over the past 30-plus years, according to the study. The state had the highest ratio of public workers who were censured for misuse of public funds and other charges.

The researchers looked at the hard numbers—federal convictions—to control for differences in spending on law enforcement and the rigor of state corruption laws.

While these numbers don’t lie, Mississippi officials were none too pleased to top this list. As the state’s top corruption fighter, Mississippi State Auditor Stacey Pickering argued in an interview with Fortune that the study relied on old data and didn’t take into account the state’s anti-corruption efforts.

“This is dated material that goes back to 1976 until 2008, the year I was sworn into office,” said Pickering.

For the rest of the story, please visit Fortune.com.

TIME Heart Disease

Mississippi Men Learn About Heart Disease — At the Barber

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John Sigler—Getty Images

Barbershops may be the new doctor's office, at least in Mississippi where African American men are learning about high blood pressure...while they get their hair cut

Barber shops and hair salons are great community hubs where residents gather for both grooming and gossip. So public health experts in the Mississippi Delta have decided to exploit these social meccas to connect with groups that don’t often see health care providers, including African American men.

Heart disease and stroke, for example, disproportionately affect this population of men, partly due to genetics, and partly due to lifestyle behaviors. But in places like the Mississippi Delta region, these men also do not get regular heart disease screenings. They do, however, go to barbershops for trims and to catch up on community news. So the Centers for Disease Control and Prevention (CDC) is funding a barbershop initiative called Brothers (Barbers Reaching Out to Help Educate Routine Screenings) located throughout the Mississippi Delta, where heart disease and stroke are the second and fourth leading causes of death in black men.

The Mississippi Department of Health spent a year recruiting and training barber shop workers on how to read a blood pressure screening, and discuss risk factors. During appointments, barbers talk to their clients about heart health, take their blood pressure, and refer them to a physician if they need further counseling. Recruitment was, and continues to be a challenge since some of the barbers were on board with the benefits of educating their clients, but worried about whether the program would hurt their business.

So far, thought, the barbers are being pretty persuasive. The project, which involves 14 barbershops that have so far served 686 men, just released its first set of data. Only 35% of the customers said that they had a doctor and 57% did not have health insurance. Among the men who received blood pressure readings, 48.5% had prehypertension, and 36.4% had high blood pressure. The findings, published in the journal Preventing Chronic Disease, shows that the program provides care to men who need it, as well as gives public health care workers a better idea of how prevalent heart disease is in the region, and how many patients are in need of medical care. The next step for the researchers is to create a community health worker network that could introduce these men to the health care system and help them navigate more regular screenings and better treatment of their condition.

Shifting health care from the clinic to the community isn’t a new idea; in some areas, health screenings and education are conducted in churches. But the faithful are a select group, and the study’s lead author says it’s important to bring services to hard-to-reach populations, such as young black men, to where they are. “We realized in our standard community health screenings–which were happening in churches–that we were not reaching adult black men,” says lead study author Vincent Mendy, an epidemiologist at the Mississippi State Department of Health. “We think the best way to reach them is through barbershops.” The program is part of a partnership between the CDC and the Mississippi State Department of Health, and is funded through September 2015.

Mendy is hopeful that the program will reach more men and bring them into treatment, since a similar 2011 initiative in Texas, funded by the National Institutes of Health, found that barbers helped to lower blood pressure in a population of African American men by 20%. Based on this growing body of research, the CDC is considering relying on community health workers to help improve the health of minority groups that have a disproportionate risk of disease and death in the U.S. — but are often outside of the health care system. Barbershops aren’t clinics, but they do seem to be a good place to get health messages across.

TIME Aids

Girl ‘Cured’ of HIV Has Relapsed

Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013.
Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013. Jay Ferchaud—University of Mississippi Medical Center/AP

"Certainly, this is a disappointing turn of events"

A 4-year-old girl believed to have been cured of HIV showed detectable levels of the virus, federal officials said Thursday in a blow to anti-HIV efforts.

The Mississippi girl had been off of antiretroviral therapy for more than two years, and doctors believed that she could serve as a model for eradicating HIV in babies born with the virus.

But on Thursday, the National Institute of Allergy and Infectious Diseases said that researchers had found detectable HIV levels in the girl this month.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement.

The girl was born with HIV, and doctors administered anti-AIDS therapy nearly immediately after her birth and continued with the treatment for months. After the girl and her mother missed several treatment appointments, doctors found that the girl was still HIV-free — leading them to believe that the early treatment may have successfully eliminated the virus. Still, experts say they knew a relapse was a possibility.

Since HIV was detected in the girl this month, doctors have resumed treatment. But despite her relapse, researchers say her case still provides a valuable understanding of early HIV treatment.

“The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period,” Fauci said in a statement. “Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

TIME sexuality

Dear White Gays: Stop Stealing Black Female Culture

You are not a black woman, and you do not get to claim either blackness or womanhood. There is a clear line between appreciation and appropriation

I need some of you to cut it the hell out. Maybe, for some of you, it’s a presumed mutual appreciation for Beyoncé and weaves that has you thinking that I’m going to be amused by you approaching me in your best “Shanequa from around the way” voice. I don’t know. What I do know is that I don’t care how well you can quote Madea, who told you that your booty was getting bigger than hers, how cute you think it is to call yourself a strong black woman, who taught you to twerk, how funny you think it is to call yourself Quita or Keisha or for which black male you’ve been bottoming — you are not a black woman, and you do not get to claim either blackness or womanhood. It is not yours. It is not for you.

Let me explain.

Black people can’t have anything. Any of these things include, but aren’t limited to: a general sense of physical safety, comfort with law enforcement, adequate funding and appreciation for black spaces like schools and neighborhoods, appropriate venues for our voices to be heard about criticism of issues without our race going on trial because of it, and solid voting rights (cc: Chris McDaniel).

And then, when you thought this pillaging couldn’t get any worse, extracurricular black activities get snatched up, too: our music, our dances, our slang, our clothing, our hairstyles. All of these things are rounded up, whitewashed and repackaged for your consumption. But here’s the shade — the non-black people who get to enjoy all of the fun things about blackness will never have to experience the ugliness of the black experience, systemic racism and the dangers of simply living while black. Though I suppose there’s some thrill in this “rolling with the homies” philosophy some adopt, white people are not racially oppressed in the United States of America.

White people are not racially oppressed in the United States of America.

White people are not racially oppressed in the United States of America.

Nothing about whiteness will get a white person in trouble the way blackness can get a black person shot down in his tracks. These are just facts. It’s not entirely the fault of white people. It’s not as if you can help being born white in America, any more than I can help being born black in America.

The truth is that America is a country that operates on systems of racism in which we all participate, whether consciously or unconsciously, to our benefit or to our detriment, and that system allows white people to succeed. This system also creates barriers so that minorities, such as black people, have a much harder time being able to do things like vote and get houses and not have to deal with racists and stuff. You know. Casual.

But while you’re gasping at the heat and the steam of the strong truth tea I just spilled,what’s even worse about all of this, if you thought things could get even crappier, is the fact that all of this is exponentially worse for black women. A culture of racism is bad enough, but pairing it with patriarchal structures that intend to undermine women’s advancement is like double-fisting bleach and acid rain.

At the end of the day, if you are a white male, gay or not, you retain so much privilege. What is extremely unfairly denied you because of your sexuality could float back to you, if no one knew that you preferred the romantic and sexual company of men over women. (You know what I’m talking about. Those “anonymous” torsos on Grindr, Jack’d and Adam4Adam, show very familiar heterosexual faces to the public.) The difference is that the black women with whom you think you align so well, whose language you use and stereotypical mannerisms you adopt, cannot hide their blackness and womanhood to protect themselves the way that you can hide your homosexuality. We have no place to hide, or means to do it even if we desired them.

In all of the ways that your gender and race give you so much, in those exact same ways, our gender and race work against our prosperity. To claim that you’re a minority woman just for the sake of laughs, and to say that the things allowed her or the things enjoyed by her are done better by you isn’t cute or funny. First of all, it’s aggravating as hell. Second, it’s damaging and perpetuating of yet another set of aggressions against us.

All of this being said, you should not have to stop liking the things you like. This is not an attempt to try to suck the fun out of your life. Appreciating a culture and appropriating one are very, very different things, with a much thicker line than some people think, if you use all of the three seconds it takes to be considerate before you open your mouth. If you love some of the same things that some black women love, by all means, you and your black girlfriends go ahead and rock the hell out. Regardless of what our privileges and lack of privileges are, regardless of the laws and rhetoric that have attempted to divide us, we are equal, even though we aren’t the same, and that is okay. Claiming our identity for what’s sweet without ever having to taste its sour is not. Breathing fire behind ugly stereotypes that reduce black females to loud caricatures for you to emulate isn’t, either.

So, you aren’t a strong black woman, or a ghetto girl, or any of that other foolery that some of you with trash Vine accounts try to be. It’s okay. You don’t have to be. No one asked you to be. You weren’t ever meant to be. What you can be, however, is part of the solution.

Check your privilege. Try to strengthen the people around you.

Sierra Mannie is a rising senior majoring in Classics and English at the University of Mississippi. She is a regular contributor to the Opinion section of the school’s student newspaper, The Daily Mississippian, where this article originally appeared.

TIME 2014 Election

McDaniel Campaign Begins Legal Challenge in Mississippi GOP Primary

McDaniel delivers a concession speech in Hattiesburg
Tea Party candidate Chris McDaniel delivers a speech to supporters in Hattiesburg, Miss. on June 24, 2014. Jonathan Bachman—Reuters

The Tea Party challenger says a write-in campaign is not off the table

This year’s most hotly contested Republican primary elections entered a new round of controversy Thursday morning, when the Tea Party challenger attempting to unseat incumbent Senator Thad Cochran officially initiated a challenge to the results of a runoff last week.

Insurgent candidate Chris McDaniel Thursday sent a “Notice of Intent to Challenge” to the Cochran campaign, the first step in an attempt to invalidate the election by revealing voting irregularities. Early next week the McDaniel campaign will file its official challenge with the state Republican Party, which oversees the primary election, McDaniel spokesman Noel Fritsch told TIME. A legal challenge in the courts will follow, Fritsch says.

“Most important in this challenge is the integrity of the election process. That’s what this is really all about,” Fritsch said. “What you have here are multiple criminal allegations, criminal misconduct.”

Cochran won a runoff against his more conservative challenger by about 6,700 votes, in part by appealing to moderates and Democrats, who were legally allowed to vote in the Republican runoff in Mississippi if they did not vote in the June 3 Democratic primary. McDaniel alleges that a significant number of Cochran votes came from Democrats who had violated that rule.

The McDaniel campaign has thus far found more than 4,900 votes it calls into question, Fritsch says. The campaign has not yet received access to records in 31 counties or to 19,000 absentee ballots, Fritsch says.

A Cochran campaign spokesman, Jordan Russell, told TIME he could not confirm the campaign had received the notice from McDaniel but called the challenge “baseless.”

“It’s not going anywhere. There’s no evidence of any wrongdoing,” Russell told TIME. “Frankly, it’s a publicity stunt, an attempt to help him to retire his campaign debt.”

Conservative activists were outraged by Cochran’s narrow victory, won with the support of Democrats after McDaniel bested the long-time Senator in the June 3 primary (neither man won more than 50% of the vote, automatically triggering the runoff). Some in conservative circles have called for McDaniel, a firebrand State Senator and former conservative radio host, to mount a write-in campaign, which may not be legally feasible under Mississippi law. A write-in effort would be good news for Democrat Travis Childers, a former congressman from Mississippi who under normal circumstances would face extremely long odds against a Republican in the deeply conservative state.

“We’ve got thousands and thousands of people telling us to do that” Fritsch said when asked if McDaniel would consider a write-in effort. “Oh no. We’re not taking any actions off the table right now.”

-With reporting from Zeke Miller

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