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Lauren Davis-June 25, 2018 Race/Class/Gender/ Society 

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Lauren Davis-June 25, 2018 Race/Class/Gender/ Society 

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NPR's TED Radio Hour Podcast - Episode from May 17, 2018 - Inspire to Action.   What motivates us to take up a cause, follow a leader, or create change? This hour, TED speakers explore stories of inspirational leadership, and what makes some movements more successful than others.

I found this episode interesting as it really dug into how we as a society gravitate towards certain causes/movements & how they impacted us - from Dr Martin Luther Kings to Emma Gonzales, survivor of the recent Florida school shooting.

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What motivates us to take up a cause, follow a leader, or create change? This hour, TED speakers explore stories of inspirational leadership, and what makes some movements more successful than others.

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Hadley Kelly -June 25, 2018- Mental, Social, Emotional, Behavioral Health

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Hadley Kelly -June 25, 2018- Mental, Social, Emotional, Behavioral Health

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Defining the scope of emotional health and how to strengthen one’s personal wellbeing is illustrated by Tanya Peterson in the article titled, “What is emotional Health? And how to improve it?” This article examines the common misconception between emotional health and mental health and how to distinguish the two. Peterson continues to discuss tips for strengthening ones emotional health and key benefits in doing so.

Peterson, T. (2015, October 13). What is Emotional Health? And How To Improve it? Retrieved from https://www.healthyplace.com/other-info/mental-illness-overview/what-is-emotional-health-and-how-to-improve-it

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What is Emotional Health? And How To Improve it? | HealthyPlace

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What is Emotional Health? And How To Improve it?

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Arianna Roberts, June 25, 2018, Laws/Policies/Politics

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Arianna Roberts, June 25, 2018, Laws/Policies/Politics

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Pharmaceutical research has shown that cannabidiol (CBD) from marijuana can successfully treat epilepsy. In a groundbreaking move, the FDA has approved the first drug containing CBD. This approval is not only important for clinical treatment, but also for law and policy. Specifically, and as stated in the article, CBD has historically been considered a Schedule 1 substance, however this new approval may mean that the DEA will change that.

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The U.S. Food and Drug Administration has approved a marijuana-deriveddrug for the treatment of two rare and serious forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, that begin in childhood but can persist in adulthood.

The drug is made from purified cannabidiol, or CBD, a compound found in the cannabis plant. The drug will be marketed under the brand name Epidiolex.

CBD has medicinal effects, but it does not cause the mind-altering high that comes from THC, the primary psychoactive component of marijuana.

The FDA says this is the first drug approved in the U.S. that contains a purified substance derived from marijuana. The agency has previously approved drugs made from synthetic versions of THC and other marijuana constituents.

"This approval serves as a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies," said FDA Commissioner Scott Gottlieb during a call with reporters about the approval.

Several states have legalized CBD oil specifically for the treatment of intractable epilepsy or seizure disorders. And, as NPR has reported, CBD supplements are available widely online and in dispensaries in the form of oils or tinctures. CBD oil has gained popularity with consumers as a remedy for a variety of other ailments. However, the legal status of these products is uncertain, as is their quality. They're not regulated the way pharmaceutical drugs are, so the consistency and dose can vary widely.

Having an FDA-approved, pharmaceutical-grade CBD drug will open up a new treatment option for epilepsy patients by delivering a high-quality, consistent dose of CBD, says Robert Carson a pediatric neurologist at Vanderbilt University who treats patients with epilepsy.

"Our biggest concerns with the artisanal [or supplement] versions of CBD were related to the consistency," Carson says. "We can't guarantee the consistency."

Carson says he will likely prescribe Epidiolex going forward. "I'm always excited about the potential for a new therapy that has been well-studied and has a great potential for benefit," he says.

Several researchers are studying the potential of CBD to treat psychiatric conditions. For instance, a clinical trial is underway to test whether CBD can be an effective treatment for people with post-traumatic stress disorder and alcohol use disorder. Another clinical trial will determine whether CBD could help prevent relapse in opioid abusers.

The approval of Epidiolex may help open the door to more CBD research, as it helps to lift one regulatory hurdle. Until now, the Drug Enforcement Administration has classified CBD as a Schedule 1 substance. Like other drugs in this category, which include heroin and cocaine, these drugs are considered to have no medical use and a high potential for abuse.

But now, with the approval of a CBD drug, the DEA will change this, according to Dr. Douglas Throckmorton, deputy director of regulatory programs at the FDA's Center for Drug Evaluation and Research,

"The DEA will need to make a different scheduling decision for CBD...because it now has an accepted medical use," he said during a conference call with reporters.

He says the reclassification is underway now.

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FDA Green Lights Marijuana-Based Pharmaceutical Drug

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The U.S. Food and Drug Administration has approved a marijuana-deriveddrug for the treatment of two rare and serious forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, that begin in childhood but can persist in adulthood. The drug is made from purified cannabidiol, or CBD, a compound found in the cannabis plant.

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"Two Common Strains Of Virus Linked To Alzheimer's Disease" is a very compelling article that outlines a correlational study between Human Herpes Virus and Alzheimer's disease. Although this could fall under the "infectious diseases" category, Alzheimer's is traditionally thought to be a disease caused by certain lifestyle choices, including or excluding a genetic predisposition. So the potential that there could be other extraneous factors contributing to the onset of this disease could prove beneficial to developing newer treatments.

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Two strains of a virus in the brain have been linked to Alzheimer's disease (AD) in the most comprehensive study of its kind ever done. It presents new evidence for how viruses might be involved in the degenerative disease and could help scientists develop new treatments in future. The study was published in the journal Neuron.

In particular, brain tissues sampled from people with AD were twice as likely to contain two common strains of the human herpes virus (HHV) than those without. Many people have HHV 6A and 7 antibodies present in their blood. It's most commonly contracted as an infant and remains dormant in the body for many years. Researchers can't say that the virus causes AD, but it could play a role in how the disease develops and progresses.

Researchers pulled raw RNA and DNA sequences from nearly 1,000 human brains both with and without AD to find new drug targets in the brain. Not initially looking for a virus, the group found that as much as half of the brain samples contained the herpes virus, with AD brains having more copies than those without.

Herpes viruses HHV 6A and 7 were found in greater abundance in brain samples from AD patients compared with normal brains. These strains could play a role in the cell death and plaque buildup seen in AD patients. Shireen Dooling/Biodesign Institute at Arizona State University

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Two Common Strains Of Virus Linked To Alzheimer's Disease

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Two strains of a virus in the brain have been linked to Alzheimer's disease (AD) in the most comprehensive study of its kind ever done. It presents new evidence for how viruses might be involved in the degenerative disease and could help scientists develop new treatments in future.

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The Food Safety Modernization Act (FSMA) was signed in 2010 and is the first update to food safety since the 1930s. I heard about this new law from a small farmer in southern Colorado who was outraged at the new regulations. The cost of implementing these new regulations will significantly impact the smaller farmers potentially putting many out of business or preventing many from entering in the first place. I found it shocking that the impact on food safety would be minimal compared to the repercussions on farmers.

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New federal food safety rules designed to protect consumers from vomit-inducing illnesses could have the unintended consequence of driving some Connecticut farmers out of business, agricultural experts say.

Connecticut's dwindling number of commercial vegetable and fruit farmers say it could cost them tens of thousands of dollars to comply with the complex regulations the U.S. Food and Drug Administration is planning to issue this year.

"I'm all for food safety," said Shelly Oechsler, a member of the family that has run Manchester's Botticello Farms for more than three decades. "But I know it's going to cost me quite a bit more money."

Oechsler said she expects her farm, which tends crops on about 400 acres in Manchester and in the Glastonbury Meadows, to take a significant hit on its already slim profit margin. "None of us are out here getting rich," she said.

"For some people, it will be too much to ask," state Agriculture Commissioner Steven Reviczky said, "and some won't want to do things differently."

George Hindinger, whose family has farmed on 120 acres in Hamden since 1893, agreed that the new rules will probably be too expensive and complicated for some Connecticut farmers, particularly older ones who won't "want to make this multiyear commitment to comply with these regulations."

MICHAEL McANDREWS, Hartford Courant

Sisters Shelly Oechsler, left, and Terry Dougan are part owners with other members of the Botticello Farm in Manchester. The family is concerned that new federal rules govering food production could severly effect the profitability of their business.

Sisters Shelly Oechsler, left, and Terry Dougan are part owners with other members of the Botticello Farm in Manchester. The family is concerned that new federal rules govering food production could severly effect the profitability of their business. (MICHAEL McANDREWS, Hartford Courant)

"I wouldn't blame anybody for saying, 'I don't feel like doing this.'"

According to the most recent U.S. Census of Agriculture, the average farmer in Connecticut is older than 58. There are an estimated 6,000 farms in the state, but 56 percent of those are limited operations that gross less than $1,500 a year, according to Henry Talmage, executive director of the Connecticut Farm Bureau.

Last year, Gov. Dannel P. Malloy was touting census figures that showed a 22 percent increase in the number of Connecticut farms between 2007 and 2012. But the statistics also indicated that most of the new farms were smaller in size, and that the value of the state's agricultural crops dropped slightly over that span.

The new regulations are expected to exempt farmers whose gross sales are less than $25,000 a year and who sell only their own fruits and vegetables directly to consumers at farm stands. Talmage said the farms facing dramatically increased FDA regulation and scrutiny are a few hundred operations with sales above that threshold - exactly the kind of commercial farmer the state is hoping to encourage.

State officials agree with Oechsler that the FDA's tough new food safety rules "are not geared for small family farms ... They are geared toward the industrial mega-farms."

The new regulations split commercial farms into categories: "Very small" operations that gross between $25,000 and $250,000 a year, "small farms" with $250,000 to $500,000 in sales annually and "large" farms that gross more than $500,000 a year. Each category has differing levels of new health regulations, and "facilities" that handle produce from multiple farms have a separate set of rules.

The proposed regulations include requirements for additional water testing, record-keeping and labeling. The law places new burdens on food companies and producers to ensure the safety of their food products and gives the FDA new power to issue recalls in the event of food-related illness outbreaks.

All the Connecticut farmers interviewed say they support the concept of improved food safety, but worry about how the rules will ultimately play out.

If the result is fewer commercial farmers in Connecticut, that would hurt efforts by the state and food activists to promote locally-grown produce as healthier and more environmentally friendly. Oechsler said she believes the end result of the new federal regulations is that consumers "will have a lot fewer local selections" when they buy produce.

Less than 1 percent of the fruits and vegetables consumed in Connecticut are grown in the state, Talmage said. The Governor's Council on Agricultural Development has set a target of increasing the amount of Connecticut-grown produce sold in the state to 5 percent by 2020.

Federal and state efforts to help farmers deal with the new rules could also be hamstrung by inadequate funding and partisan budget battles in Congress, said U.S. Rep. Rosa DeLauro, D-3rd District. "This hurts everyone," DeLauro said of the funding issue. "Democrats, Republicans, Independents - I don't care who you are."

DeLauro, one of the authors of the Food Safety Modernization Act, said lack of money for the program is likely to curtail federal and state efforts to educate farmers about the new requirements and help them adapt to the stricter rules for how produce is grown, harvested and transported.

The law was passed in 2010 in response to increasing incidents of tainted food ranging from peanut butter to lettuce. The FDA now has increased authority and monitoring responsibilities to insure the safety of produce grown here or abroad.

DeLauro said the FDA has already "made significant changes" in its proposed rules in an attempt to make things easier for smaller farmers.

"No one is trying to put people out of business," DeLauro said. She said the intent of the new growing and handling rules is to "create a culture of food safety."
Targeting Norovirus
The federal Centers for Disease Control estimates that about 48 million Americans get sick every year from the food they eat, and about 128,000 become ill enough to be hospitalized.

Most cases are food poisoning. The CDC reported that in 2012 there were 1,632 food illness outbreaks (involving two or more people getting sick from the same food source), including 17 in Connecticut. Those outbreaks caused 29,112 people to get sick, with 1,750 hospitalizations and 68 deaths.

Dairy, meat, fish and shellfish are already subject to strict federal rules. The CDC found that restaurants are the source of 60 percent of food-illness outbreaks.

The FDA's new farm safety rules target the 46 percent of the illnesses caused by the norovirus, and the most common form of transmission is leafy vegetables like lettuce and spinach. CDC experts say the norovirus is commonly spread to vegetables through fecal-contaminated water.

According to the CDC's website, "Norovirus is a very contagious virus that can infect anyone. You can get it from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes your stomach or intestines or both to get inflamed. This leads you to have stomach pain, nausea, and diarrhea and to throw up."

One of the potentially most expensive new rules for Connecticut farmers involves testing of water used to irrigate crops or wash vegetables. If a farmer sells produce from a neighbor's farm as well as his or her own crops (Hindinger and Oechsler say that's becoming more common), then that operation is subject to even stricter regulation.

"The level of regulation and the complexity of rules is going to increase substantially," Reviczky said. The agriculture department is now in the process of awarding $250,000 in state grants to Connecticut farmers who are asking for help with costly capital improvements they will need to comply with the new FDA rules. The grants will pay for things like new washing stations, well-drilling equipment and plastic storage bins.

That particular source of state support for farmers could be drying up. The money came from the state's Community Investment Act, and Malloy's administration has proposed cutting $15.2 million from that fund to help close the state's deficit.

DeLauro said federal funding to put the new food safety rules into effect is also now a major concern, in part because of the anti-spending attitudes of Republicans who control both chambers of Congress.

According to Congressional Budget Office estimates, the FDA would need about $580 million between 2011 and 2015 to achieve the food safety goals of the new law. Less than half of that amount has been appropriated by Congress.

The FDA is now asking for $109.5 million for the next fiscal year to pay for implementing the law. DeLauro thinks that's far too low a figure: "I'm requesting $300 million in fiscal year 2016," she said.

Talmage, head of the farmer-supported Connecticut Farm Bureau, said most farmers in Connecticut blame the huge industrial-scale farming operations in the Midwest and Western states for the demand for more food safety.

"Our farmers say, 'We're not the problem - the problem is with the mega-farms,'" Talmage said. He said the FDA's position is "there is no justification to think that local food is safer."

Talmage points out that, even without the new FDA rules, Connecticut farmers are under pressure to meet more stringent health and safety requirements from supermarkets, restaurants and individual consumers. "The marketplace is requiring more of this anyway," Talmage said.

Farmers like Hindinger and Oechsler say they are still uncertain how much of a financial pinch the new FDA food safety regulations will cause. "It's so confusing," Oechsler said.

"We just want to make sure that none of these rules are so onerous that we can't continue to do business," Hindinger said. "We're in a low-margin business ... When you add thousands of dollars to your costs, it's hard to make that up."

Reviczky is worried that Connecticut agriculture could see a repeat of what happened in the 1960s when new federal health rules governing milk production pushed many of this state's small dairy farmers out of business.

"That's not what we want to see happen with our vegetable farmers," the commissioner said. "We were experiencing a renaissance in agriculture in Connecticut ... and we want that to continue."

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State Farmers Say New Food Safety Rules Will Be Costly

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New federal food safety rules designed to protect consumers from vomit-inducing illnesses could have the unintended consequence of driving some Connecticut farmers out of business, agricultural experts say. Connecticut's dwindling number of commercial vegetable and fruit farmers say it could cost them tens of thousands of dollars to comply with the complex regulations the U.S.

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This TED talk, “Let’s put birth control back on the agenda”, was done by Melinda Gates in Spring 2012 and brings attention to the inequalities in birth control. She suggests giving all women access to birth control is a simple approach that could be a catalyst to social change and inequality that is present around the world. This ability to choose when to have children and possibly choose to have smaller families has the potential to create increases the children’s health, the parents’ health, and children’s education.

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TED Members help billions of people worldwide access inspiring ideas. Plus, they get exclusive benefits like invite-only events with speakers. Join today for a brighter future - and a better you.

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Melinda Gates: Let's put birth control back on the agenda

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Contraception. The topic has become controversial in recent years. But should it be? Melinda Gates believes that many of the world's social change issues depend on ensuring that women are able to control their rate of having kids.

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Hunter Hudson, June 26th, Environmental Health

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Hunter Hudson, June 26th, Environmental Health

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This article is about a diabetes drug that is becoming more and more prevalent in the water supply. The problem with the drug is that it is feminizing fish and disrupting their fertility. This could have impacts on human population particularly on how the drug, metformin, could be a potential endocrine disrupting chemical with impacts on human fertility as well.

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Male minnows exposed to a widely used diabetes drug ubiquitous in wastewater effluent had feminized reproductive parts and were smaller and less fertile, according to a new study.

It is the first study to examine the drug metformin's impact on fish endocrine systems and suggests that non-hormone pharmaceuticals pervasive in wastewater may cause reproductive and development problems in exposed fish.

Metformin is largely used to combat insulin resistance associated with type-2 diabetes, which accounts for about 90 percent of all diagnosed U.S. adult diabetes cases.

Researchers from the University of Wisconsin-Milwaukee exposed young fathead minnows to water containing levels of metformin commonly found in wastewater effluent. Eighty-four percent of 31 metformin-exposed male fish exhibited feminized reproductive organs.

"Normally in females you see eggs developed in ova, in males, you see a different structure - producing tiny sperm instead of an egg structure," said Rebecca Klaper, an associate professor at the University of Wisconsin-Milwaukee and senior author of the study. "We saw development of larger egg structures within the [male's] testis."

A couple of non-exposed males had very minor feminization, but signs of egg development were nothing compared to what happened in the exposed fish, Klaper said. In addition to the feminization, exposed male minnows weighed less and had significantly less babies when they reproduced, suggesting that the feminization may impact their ability to reproduce properly.

Pharmaceutical chemicals are ubiquitous in wastewater effluent. Researchers estimate that, by mass, metformin is among the most common pharmaceutical in wastewater.

More than nine percent of the U.S. population has diabetes, according to the Centers for Disease Control and Prevention. The agency estimates that from 1980 to 2011, cases of diagnosed diabetes almost tripled.

Increased illnesses means more drugs. Pharmaceutical drugs get into our wastewater when people flush their medication or, more commonly, when they excrete them. Metformin, unlike many pharmaceutical drugs, is not metabolized by the human body, and gets excreted unchanged.

Metformin's "really been hitting people's radar more of late," said Dana Kolpin, a U.S. Geological Survey research hydrologist based in Iowa and project chief of the agency's emerging contaminants project. Kolpin said as water testing methods have gotten more sophisticated, metformin seems to be one of the most frequently detected. "It's persistent and mobile," he said.

Scientists have expressed concern that birth control and other hormone mimicking drugs in water could impact fish populations and cause feminization. Last year U.S. Geological Survey researchers reported intersex fish in Pennsylvania's Susquehanna, Delaware and Ohio river basins, suggesting that estrogenic chemicals were to blame.

However, metformin is not an estrogenic or hormone-mimicking drug. Rather it is designed to improve insulin sensitivity. It appears a "nontraditional endocrine disrupting chemical," Klaper and her University of Wisconsin-Milwaukee colleague, Nicholas Niemuth, wrote in the study published in the journal Chemosphere.

While researchers are not totally clear how the drug disrupts fish hormones, metformin has been shown to alter the activity of certain enzymes that are involved in hormone pathways.

"We know from some vertebrate studies that insulin and metabolism in an organism is tied into reproduction," Klaper said. "But how metformin would cause a difference in actual egg production is something we don't know but is very interesting. Now we're trying to figure out why."

Klaper previously found that metformin caused some signs of endocrine disruption when she exposed adult fish to the drug for 28 days. However, no intersex tissue was found, suggesting that exposure during development might be the major concern.

It's not clear if all fish would react to metformin exposure as the fathead minnows did, Kolpin said. Klaper said the development of male and female fish is not entirely the same across species. She said they would continue testing fathead minnows and also look at zebrafish to see if they exhibit similar impacts.

Kolpin said some waterways also have been shown to have a metformin transformation compound, called guanylurea, which is formed when metformin comes in contact with bacteria such as in sewage.

"It'll be worth finding out if its transformation product also has these bioactive properties," Kolpin said.

The U.S. Environmental Protection Agency's latest drinking water contaminant candidate list -water pollutants not subject to regulations yet but that might render water unsafe-includes several pharmaceuticals that act on hormones. Metformin is not on the list, published in February.

Klaper and Niemuth wrote that metformin would probably not show up as an endocrine disruptor under the current testing used by the U.S. EPA Agency, which relies on the binding of chemicals to hormone receptors. Structurally, metformin doesn't resemble hormones. The results, they argue, suggest the EPA should broaden its testing.

"Given its environmental persistence and presence worldwide, this compound merits further research on its potential environmental impacts as well as its impacts on vertebrate development more generally and should be added to the list of potential EDCs [endocrine disrupting chemicals]," Klaper and Niemuth wrote.
This article originally ran at Environmental Health News, a news source published by Environmental Health Sciences, a nonprofit media company.

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Brian Bienkowski, Environmental Health News

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Diabetes Drug Makes Male Minnows More Female

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Male minnows exposed to a widely used diabetes drug ubiquitous in wastewater effluent had feminized reproductive parts and were smaller and less fertile, according to a new study. It is the first study to examine the drug metformin's impact on fish endocrine systems and suggests that non-hormone pharmaceuticals pervasive in wastewater may cause reproductive and development problems in exposed fish.

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Aspen Becker, 6/26/18, Environmental Health

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Aspen Becker, 6/26/18, Environmental Health

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This article discusses the ways in which climate change is specifically impacting Denver. Such as, more high heat days and more frequent drought and flood events. As well, it goes into detail about what Denver is trying to do to combat these issues, like receiving the Bloomberg Philanthropies grant, and what you can do to help as a resident of Denver.

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How does Climate Change Affect Health in Denver?

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In Denver, heat-related morbidity and mortality rates will increase, as well as negative effects for those with respiratory disease. Denver has a long and distinguished history of working to improve air and water quality, safeguarding the climate and protecting public health. Many of the same activities that contribute to climate change also produce other pollutants that harm health.

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Jimmy Winslow        6/26/18         Mental/Social/ Emotional/Behavioral Health

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Jimmy Winslow        6/26/18         Mental/Social/ Emotional/Behavioral Health

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This Ted Talk illustrates how depression is one of the best documented problems but least discussed. Kevin describes how people are so much more willing to help people with physical injuries but stigmatize mental ones. He believes that the more we are willing to talk about mental health problems, the more we will accept it not as an identity or weakness but as a illness just like any other one.

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Kevin Breel: Confessions of a depressed comic

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Kevin Breel didn't look like a depressed kid: team captain, at every party, funny and confident. But he tells the story of the night he realized that -- to save his own life -- he needed to say four simple words.

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Infectious/Communicable Diseases
In his first interview as the head of the CDC, Robert Redfield, MD, touches on many topics including HIV/AIDS prevention and pandemics. Dr. Redfield says his top priority is to protect Americans from major global epidemic threats, namely pandemic flu and antimicrobial resistance.

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centers for disease control and prevention

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centers for disease control and prevention

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New CDC Director Targets Opioids, Suicide and Pandemics

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In his first interview as the head of the CDC, Robert Redfield said his goals include combating the opioid epidemic, ending the HIV/AIDS epidemic in America and strengthening public-health systems in countries where epidemics are a risk.

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Infectious/Communicable Disease

In this This American Life Podcast, the host dives into the power of Gossip. While we may not often think of gossip as a "good/beneficial" cultural interaction, Act One of the podcast tells the story of sociologist Susan Watkins's study of how Malawians are using gossip to determine who is safe to date or marry in a country ravaged by HIV and AIDS. The study also involved asking locals to document any "rumors" that they heard relating to HIV and AIDS in the community.

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Related

If you enjoyed this episode, you may like these

Staff Recommendations

We go to the Lower 9th Ward in New Orleans to talk to residents about what matters most to them ten years after the hurricane.

The startling rise of the number of people on disability in America.

Senior producer Julie Snyder and her husband Jeff talk to guest host Sarah Koenig about gossip that takes place-where else?-in a beauty salon. (8 minutes)

In Malawi, in southeast Africa, not gossiping can be worse than gossiping. Sarah interviews a young Malawian woman named Hazel Namandingo, who explains that because so many people have HIV and AIDS in Malawi, they often rely on gossip to figure out who's safe to date or marry. It turns out this kind of gossip is the basis for a huge research project about AIDS in Malawi. For 10 years, a sociologist named Susan Watkins has been collecting journals filled with gossip about AIDS. Watkins hired local people to write the journals-to just listen to what people were saying in their communities about the virus, and then write it down. What Watkins learned from reading them bucked much of the conventional wisdom about how rural Africans were dealing with the epidemic. (Plus, they're really entertaining.)

There's a U Penn website that explains the Malawi Journals Project. And an NGO in Malawi called Invest in Knowledge has catalogued the journals. (30 minutes)

Chicago writer Rebecca Makkai bring us the story of a reality television producer attempting to gossip love into existence-and just how complicated that gets. This fiction story originally appeared in the journal Crazyhorse. Rebecca is the author of the novel The Borrower, and "The November Story" is part of her collection-in-progress Music for Wartime. (18 minutes)

We go to the Lower 9th Ward in New Orleans to talk to residents about what matters most to them ten years after the hurricane.

The startling rise of the number of people on disability in America.

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If you enjoyed this episode, you may like these We go to the Lower 9th Ward in New Orleans to talk to residents about what matters most to them ten years after the hurricane. The startling rise of the number of people on disability in America.

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Environmental Health
June 28, 2018
New research suggests that storms, intensified by climate change, will have a big impacts on the world's fisheries, particularly off the coast of the coast of the UK. The world's fisheries contribute to the economy of developed nations, but also provide food for those in developing areas. The world's fisheries support "12% of the global population and 38 million fishermen and women." These researchers even make the bold claim that storms will have a greater impact on fish populations than ocean warming - also caused by global climate change.

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Potential changes in the frequency and intensity of storms off the coast of the UK and around the world could have a "catastrophic impact" on the livelihood of fishermen and sustainability of fishing industries, research led by the University of Exeter has shown.

The research, based on a review of past studies and examination of future projections, warns that the increase in storms could make fishing more dangerous, displace fish from their natural habitats and interfere with the ability of fish to breed.

Storms off the coast of the UK are projected to become more frequent and intense over the next two centuries and more dramatic storms are expected in the North Sea and North Atlantic, to the West of the UK, Ireland and France, threatening the future of fishermen and the fish they catch.

The paper, Changing Storminess and Global Capture Fisheries, published in the journal Nature Climate Change, says detailed projections and stimulations are urgently required to predict more precisely where storms are likely to hit in future and to support fishing communities to adapt to this element of climate change.

The team of experts from the University of Exeter, Met Office, University of Bristol and Willis Research Network, urges climate-change research to focus sharply on the increase in frequency and intensity of storms as a priority.

Lead author Nigel Sainsbury, of the University of Exeter, said: "Storms are a threat to fishermen's safety, productivity, assets and jobs and to the health of billions of people around the world who rely on fish for their daily nutrition.

"Changing storminess could have serious consequences for vulnerable coastal communities around the world. Conducting research in this area is critical to support the adaptation of fisheries to climate change."

The research, which includes a review of storm projection studies, highlights a potential greater exposure to tropical cyclones towards the East China Sea and increased post-Monsoon storms in the Arabian Sea. In contrast, storms in the Mediterranean are likely to reduce over the next two centuries. Over the next 200 years, the frequency and intensity of storms are projected to increase in the Eastern North Atlantic (i.e. to the west of UK, Ireland and France) during autumn and winter.

Storms not only pose a threat to the safety of fishermen at sea, or keep them in port, but kill fish and destroy their habitats, affecting the livelihood of fishermen who rely on them.

In the UK the fishing industry contributes £1.4 billion to the UK economy and is an important source of jobs for coastal communities from Cornwall to the Shetland Islands.

Associate Professor Steve Simpson, a marine biologist at the University of Exeter ad co-author in this study, warned: "Our past research has shown how warming seas gradually change the composition of fisheries by shifts in distribution.

"But storms can radically change fish populations via temporary or permanent displacement, and can interrupt fish larval dispersal and damage or destroy essential habitat that fish depend upon."

Fishing and fish farming supports 12% of the global population and 38 million fishermen and women.

Fish provide 3.1 billion people with close to 20% of their animal protein, and are relied upon for micro-nutrients, vital to the health of children and pregnant women.

Co-author Geoffrey Saville, of Willis Research Network, said: "Research is required to identify and evaluate ways in which fisheries can adapt to changing storminess. One possibility that we believe is worth investigating is the adoption of financial mechanisms that are already being used to help farmers to recover from drought."

The researchers call for a sharper focus on the impacts of storms which have "the potential to cause more immediate and catastrophic impacts" than ocean warming.

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fish; fisheries; marine biology; nature; severe weather; storms; global warming; environmental issues

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Increase in storms could have 'catastrophic impact' on fishing industry

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Potential changes in the frequency and intensity of storms off the coast of the UK and around the world could have a "catastrophic impact" on the livelihood of fishermen and sustainability of fishing industries, research led by the University of Exeter has shown.

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Rick DeVoss June 28. 2018, Race/Gender/Society

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Rick DeVoss June 28. 2018, Race/Gender/Society

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This article from Kaiser Health News highlights the situation where eligible children are not receiving health benefits due to fear from their immigrant parents. In a particularly tense time within the immigrant community and with fears at an all time high, it is no surprise that enrollment is down among these children. After all, the conversation for obtaining medicaid contains very personal questions parents can easily view as setting themselves up for deportation.

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This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

This story can be republished for free ( details).

The fear of family separation is nothing new for many immigrants already living in the U.S. In fact, that fear, heightened in recent weeks, has been forcing a tough decision for a while. Advocates say a growing number of American children are dropping out of Medicaid and other government programs because their parents are not citizens.

Marlene is an undocumented resident of Texas and has two children who are U.S. citizens who qualify for Medicaid, the federal-state program for low-income people. (Kaiser Health News is not using Marlene's last name because of her immigration status.) One of her children has some disabilities.

"My son is receiving speech therapy," she said in Spanish. "But it's been difficult."

It was a long journey to get the right evaluations and diagnoses, and her son is finally making progress, Marlene said. But she braces for a day when he might have to do without this therapy and others that are paid for through Medicaid. Because she's undocumented, she's extremely nervous about filling out applications for government programs like this.

Already, she has decided to stop receiving food stamps, now known as SNAP, which her children, as citizens, are entitled to based on the family's income.

She dropped it because the application to receive those benefits changed, she said.

"They are asking a lot of questions," she said. "They are investigating one's life from head to toe."

Marlene said she was nervous, in particular, about being asked to provide years of pay stubs and other eligibility requirements she had not experienced before. Marlene said the application alone made her "sick from stress."

Repeated calls and emails to Texas health officials to ask about the changes in the benefits application process went unanswered.

Marlene's son has Medicaid for the next several months. But she is worried how that application will change, too, next time she has to apply.

Health care groups say they've observed other immigrant families making similar choices, and they think it will accelerate if a proposed change to green card eligibility becomes law. Under the proposed change, if family members receive government services - even if those family members are citizens - it would ding the applicants' chances of approval for permanent residency.

"We are seeing families having to make this impossible choice," said Maria Hernandez, the founder of Vela, a nonprofit in Austin that helps parents who have children with disabilities.

Hernandez instructs parents how to advocate for their children and how to find the appropriate health care and therapies for their kids, and helps them find community support, among other things.

She conducts many of these classes in what used to be an elementary school on the east side of Austin, known as one of the most diverse areas of the city. She said about seven in 10 of the families she works with are immigrants - mostly from Mexico.

"We are working with families who the parents are immigrants but the children are born here," Hernandez said.

Parents tell Hernandez they feel like they can't risk any attention from the government, even if that means losing badly needed benefits for their kids.

In the first year of the Trump administration, Central Texas experienced an uptick in immigration raids and deportations. Since then, Hernandez said, a lot of people in the immigrant community have been making critical choices out of fear.

"It's out of fear of deportation," she said. "It's out of fear of having their children being penalized in some way and potentially losing a parent that until this point has been their fierce advocate."

In Texas, this is a decision that is bound to affect a significant number of children, said Anne Dunkelberg with the Center for Public Policy Priorities in Austin. Dunkelberg has been closely watching various immigration proposals and their effect on access to government services.

"A quarter of Texas children have at least one parent who is not a U.S. citizen," she said. "Now, I am sure that not a hundred percent of those kids - and it's about 1.8 million kids - not a hundred percent of them are using a public benefit, but a very high percentage will be."

Dunkelberg said families opting out of Medicaid could further raise the number of uninsured in Texas, which is already the highest in the nation.

Hernandez said parents who have children with disabilities have told her that without Medicaid they'll rely on emergency rooms "as needed."

"We know that that is not a good plan for kids that for forever have been followed by a neurologist because they have seizures or have been going to occupational therapy for years and are finally making progress," she said.

Approximately 10 million citizen children in the U.S. have at least one non-citizen parent.
This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

This story can be republished for free ( details).
KHN's coverage of children's health care issues is supported in part by the Heising-Simons Foundation.

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Fearing Deportation, Immigrant Parents Are Opting Out Of Health Benefits For Kids

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This story is part of a partnership that includes KUT, NPR and Kaiser Health News. This story can be republished for free ( details). The fear of family separation is nothing new for many immigrants already living in the U.S. In fact, that fear, heightened in recent weeks, has been forcing a tough decision for a while.

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Kaci Pickett 6/28/18 Infectious/ Communicable Diseases

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Kaci Pickett 6/28/18 Infectious/ Communicable Diseases

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This is an interesting perspective on pathogenic diseases from an evolutionary biologist's perspective. He uses the specific example of the spread of "germs" that cause diarrhea.

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Evolutionary biologist Paul Ewald drags us into the sewer to discuss germs. Why are some more harmful than others? How could we make the harmful ones benign? Searching for answers, he examines a disgusting, fascinating case: diarrhea.

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This story from NPR describes how pharmaceutical companies have significantly cut back on payments to physicians in marketing opioid pain medications in an effort to curb the opioid epidemic. While this is encouraging to see it demonstrates the tremendous behavior modification that pharmaceutical payments can make. It seems important that scrutiny of pharmaceutical payments to physicians is necessary to prevent undue bias so that patients receive high quality, evidence based care.

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The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic.

Lawsuits and media reports have accused Purdue Pharma, the maker of OxyContin, of aggressively marketing the powerful narcotic even after it knew the drug was being misused. Prosecutors have charged the founder of Insys Therapeutics and several of the company's sales representatives and executives for their roles in an alleged conspiracy to bribe doctors to use its fentanyl spray for unapproved uses. State and local governments have sued a host of drug makers, alleging they deceptively marketed opioids and seeking to recoup what it costs to treat people addicted to the drugs.

But as public attention increases, the marketing tide may finally be retreating, a new ProPublica analysis shows. Pharmaceutical company payments to physicians related to opioid drugs decreased significantly in 2016 from the year before.

In 2016, drugmakers spent $15.8 million to pay doctors for speaking, consulting, meals and travel related to opioid drugs. That was down 33 percent from $23.7 million in 2015 and is 21 percent less than the $19.9 million in spent in 2014. Companies are required to report the payments publicly under the Physician Payment Sunshine Act, a part of the 2010 Affordable Care Act.

ProPublica analyzed these payments in conjunction with our update of Dollars for Docs, an online tool that allows users to view and compare promotional payments to doctors from drug and medical device companies. We updated the tool Thursday to add payments to doctors for 2016. It now includes more than $9 billion in payments since 2013 to more than 900,000 doctors.

Among opioids, the biggest decreases in spending were for Subsys, the fentanyl spray that has spawned criminal charges against officials and sales representatives at drug maker Insys, and Hysingla ER, an extended-release version of hydrocodone made by Purdue Pharma.

Payments related to Subsys decreased from more than $6 million in 2015 to less than $2.4 million in 2016. Payments for Hysingla dropped from about $6.3 million in 2015 to $2.2 million in 2016.

Dr. Scott Hadland, an assistant professor of pediatrics at Boston University School of Medicine who has studied opioid marketing, said the decreases were "impressive" but not surprising given the growing awareness and concern about pharmaceutical companies' marketing of opioids.

He said it's difficult to pinpoint a single reason behind the drop, but "it's possible that the pharmaceutical companies voluntarily reduced their marketing, realizing that they may have been contributing to overprescribing."

A number of studies have shown a correlation between marketing of opioids and doctors' prescribing of the drugs. Hadland and his colleagues reported in May that for every meal a physician received related to an opioid product in 2014, there was an increase in opioid claims by that doctor for Medicare patients the following year. And a report from the New York State Health Foundation published this month found that physicians who received payments from opioid makers prescribed more opioids to Medicare patients than doctors who didn't receive the payments.

The sharp drop in marketing is more pronounced than the much-slower reduction in the use of prescription opioids. The number of opioid prescriptions in Medicare, the public health program for seniors and the disabled, peaked at 81.7 million in 2014, and then dropped to 80.2 million in 2015 and 79.5 million in 2016, according to the Centers for Medicare and Medicaid Services. (Enrollment in Medicare's prescription drug program continued to grow during that time, so the rate of opioid prescriptions per beneficiary dropped even more.)

Still, the toll of opioid overdoses continues to grow. Some 42,000 people died of opioid overdoses in 2016, the most recent year available, and about 40 percent of those involved a prescription opioid. The epidemic has shifted somewhat away from prescription drugs as more people die of heroin and synthetic opioids like fentanyl.

The public attention has prompted the makers of prescription opioids to revamp their marketing practices.

Purdue Pharma, which has received the most attention because of its one-time blockbuster OxyContin, has ratcheted back its spending on doctors, especially for programs in which doctors talk to their peers over lunch or dinner to help companies market their products. Purdue ended its speaker program for OxyContin at the end of 2016 and for Hysingla ER in November 2017. Earlier this year, it ended all direct promotion of its opioids to prescribers and last week, the company laid off its remaining sales representatives.

Purdue spokesman Robert Josephson said in an email that payments to doctors related to opioids have decreased since 2016 and that there would be very little such spending in 2018.

In 2007, Purdue and three of its executives pleaded guilty to charges of "misbranding" OxyContin and collectively agreed to pay more than $634 million in penalties. In more recent years, though, the company has pushed back against allegations that it has fanned the opioid epidemic, saying it has worked to be part of the solution.

Insys also has been the subject of multiple federal and state investigations related to its marketing of Subsys. The company ended its speaker program for Subsys earlier this year and said it has refocused its sales staff primarily on oncologists who treat patients with severe cancer-related pain, what the drug was initially approved to treat. "Insys is a new company in important aspects, comprised of people who are firmly and sincerely committed to helping patients in need and doing the right things in the right way," company spokesman Joseph McGrath said in an email.

Insys' founder John Kapoor has pleaded not guilty to charges of conspiracy to commit racketeering, mail fraud and wire fraud. Some former sales representatives, managers and doctors have pleaded guilty for their roles in the conspiracy detailed by federal prosecutors; others are awaiting trial.

One product that saw increased promotion in 2016 was Opana ER, a pain medication made by Endo Pharmaceuticals. The company pulled the drug from the market in late 2017 at the request of the Food and Drug Administration, after it was linked to a 2015 outbreak of HIV in rural Indiana among intravenous drug users who crushed Opana and injected it with shared needles.

Endo spent about $121,000 on payments to doctors related to Opana in 2015 and $229,000 in 2016.

"Pharmaceutical manufacturers are legally permitted in the U.S. to promote all FDA-approved products to physicians in accordance with the subject product's label," Endo said in a statement. "This includes opioid products, which are safely used by millions of Americans to improve their quality of life."

That said, Endo said it stopped promoting Opana ER in the United States in January 2017 before voluntarily withdrawing the drug in September. "Today, Endo does not promote any opioid products to U.S. physicians," the company said in a statement.

Some opioids that contain the drug buprenorphine also bucked the downward trend in payments to doctors. Companies spent more than $4.4 million in 2016 promoting the drugs Belbuca, Butrans and buprenorphine, which experts say are less prone to abuse and carry a lower risk of overdose. That was nearly double the amount spent on those drugs in 2015. Almost the entire difference was attributable to Belbuca, which was approved by the FDA in late 2015.

Purdue, which makes Butrans, stopped its speaker program for the drug at the end of 2016. Endo marketed Belbuca until December 2016 and then returned its license to BioDelivery Sciences International Inc., which has marketed the product since then.

Dr. Michael Barnett, an assistant professor of health policy and management at Harvard School of Public Health, said it's hard to say for certain why marketing has decreased for opioids.

"Given the deluge of media attention with the opioid epidemic, I think we've seen the pendulum swing in the opposite direction," he said, from opioids being seen as a compassionate way to treat pain to "being viewed as pretty toxic and only to be used as a last resort."

Barnett said if marketing of opioids continues to decline, "it's potentially good news."

"If this is actually a result of manufacturers actually saying, 'Holy crap, people actually care about opioids being used responsibly' and they're aware that their advocacy and payments to physicians could be seen as pushing these medications in a way that is ethically dubious, then that's a beneficial development and something I'd like to see more of."

Check whether your doctor has received payments from pharmaceutical and medical device companies using our Dollars for Docs tool.

ProPublica is a nonprofit newsroom based in New York. You can follow Charles Ornstein and Ryann Grochowski Jones on Twitter: @charlesornstein and @ryanngro.

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Opioid Makers Cut Back On Marketing Payments To Doctors

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The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic. Lawsuits and media reports have accused Purdue Pharma, the maker of OxyContin, of aggressively marketing the powerful narcotic even after it knew the drug was being misused.

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The Trump Administration cut the EPA's budget by an additional 24% in February which means that there will be fewer funds available for supporting research in endocrine disrupting substances and computational toxicology

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This website notes current state policies for opioid prescriptions. States like Florida and Michigan passed policies just yesterday to limit the number of days a patient with acute issues would be on opioid medications to 3 and 7 days respectively. Other states, however, (Colorado included) do not have statutory limits. This shows that opioid control, while getting stricter, depends a lot on the state you live in and physician discretion.

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This article discusses how in New York in health courses students will be given information and material on how to deal with mental health issues. I think that this is a really important move by the educational system to acknowledge mental health issues and help give student information and tools. There is one million dollars in grants to help develop the curriculum. This goes a long way to helping address the mental health of the people and finally starts to address it at a younger age. This will hopefully make it less of a taboo or sigma and help get adolescents even more help and resources for dealing with mental illness.

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CLOSE

ALBANY - When students return to school this fall, there will be a new lesson for them to learn: how to deal with mental-health issues.

A state law adopted in 2016 goes into effect July 1 that requires school districts to provide mental-health education as part of its health courses.

Mental-health groups and lawmakers pushed for years to make the measure law, saying students in elementary through high school should get a better understanding of the aspects of mental health.

Gov Andrew Cuomo signed the bill into law in September 2016.

"This groundbreaking law lays the path to better health for all New Yorkers," said Glenn Liebman, CEO of the Mental Health Association in New York State.

"While first starting in schools, we believe that ultimately this law will have a far-reaching effect for communities across New York state."

Advocates said the new law is the first of its kind in the nation and will help students better understand mental health, how to recognize problems they or others are facing and how to get treatment.

The state Education Department said it will soon provide schools with guidance on how to incorporate lessons on mental health into their curriculum, said MaryElla Elia, the state education commissioner.

"The public is finally coming around to the notion that to properly address mental health issues, we must first acknowledge and openly discuss them," Elia said in a statement provided by the the Mental Health Association.

Supporters of the law noted that one in five adults in the U.S. are believed to be afflicted with mental illness, and about half of the cases start during a person's teenage years, according to the National Institute of Mental Health.

The new law requires mental-health education, but does not mandate specific curriculum, according to the Mental Health Association.

So the non-profit group received a $1 million state grant to develop the School Mental Health Resource and Training Center that will serve as a clearinghouse for schools on how to develop mental-health lessons.

More: Erica Bryant: Don't blame school shootings on mental illness

More: Heroin spending: NY lawmakers vow investigation into state program

More: Property-tax cap: How Cynthia Nixon and Andrew Cuomo differ

Read or Share this story: https://on.rocne.ws/2ICLI2C

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Coming to New York classrooms: Lessons on mental health

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CLOSE ALBANY - When students return to school this fall, there will be a new lesson for them to learn: how to deal with mental-health issues. A state law adopted in 2016 goes into effect July 1 that requires school districts to provide mental-health education as part of its health courses.

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Melissa Lowe- June 30th Law/Policies/Politics

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Melissa Lowe- June 30th Law/Policies/Politics

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This article discusses a current lobbying effort in Colorado to raise the age to purchase tobacco products to 21 in an effort to combat the high levels of vaping in Colorado among teenagers. Colorado is 13th in the nation for e-cigarette use among teenagers according the CDC. Many teenagers start vaping before they turn 18 but the thought is that raising the age to purchase will keep more tobacco from reaching younger consumers.

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Audio: Raise the age for tobacco purchase to 21? John Daley reports

Colorado tops 37 other states for e-cigarette use among high school students, according to a national school-based survey by the Centers for Disease Control and Prevention. More than a quarter of Colorado high schoolers currently use e-cigarettes and almost 6 percent say they use them frequently.

The state had a high vaping prevalence, but Alison Reidmohr, tobacco communication specialist with the Colorado Department of Public Health and Environment, was "surprised to see the highest in the nation." She noted it's nearly double the national average, and appears to be driven by the popularity of the Juul brand.

The finding, based on states that participated in the survey and had available data, coincides with a push in several Colorado mountain towns to raise the minimum age for tobacco and nicotine purchases.

The resort town of Aspen passed the state's first such law in 2017. Neighboring Basalt followed suit. Mandy Ivanov, nearby Eagle County's health promotion coordinator, said most adult smokers in the U.S. started before they were 18. Her summer health intern, 16-year-old Eagle Valley High student Lilly Reynolds, is working on the project because she sees the rising number of classmates vaping, many using Juuls.

"I could see definitely down the road this getting kind of worse," said Reynolds, who estimates a third of her classmates vape regularly, often ducking into the school bathroom. "But I think right now, we kind of need to do what we can, and I think Tobacco 21 as a good place to start with that."

Tobacco 21 is a national campaign to raise the minimum legal age for sales of tobacco and nicotine.

Dr. Kim Levin, an emergency room doctor and Pitkin County medical officer, is "very concerned about Juuls," and said Tobacco 21 will cut down on sales between "social sources" - older teens buying the sleek and small e-cigarettes for their younger peers. And that, she said, will lead to fewer teens becoming adult smokers.

"If you cut off that supply from the 18-year-olds, it's really going to be a lot harder for a freshman and for a sophomore in high school to be getting them," Levin said.

The debate echoes a wave of fights nationally over tobacco. Earlier in June, voters in San Francisco upheld, by a wide margin, a ban on the sale of flavored vaping products. The industry poured money into a failed effort to stop the ban.

In Colorado, industry groups are also taking a position. Tom Briant with the National Association of Tobacco Outlets likens the position of raise the age advocates to "a nanny states-type situation."

Groups representing tobacco, vaping and convenience store interests all oppose Tobacco 21. Briant's group represents 60,000 retail stores that sell tobacco. At 18, you get certain rights and privileges, like running for public office, the ability to marry or buy a car, he said.

"You're now an adult," Briant said. "So you should be, at that age, able to make your own decisions on what legal products you purchase or not."

There's another group against the Tobacco 21 initiative: The Colorado Wyoming Petroleum Marketers Association, which represents 2,200 retailers, including convenience stores. Executive Director Grier Bailey said that a few years ago, Colorado lawmakers opted not to take Tobacco 21 statewide. For Bailey, local laws raising the purchase age won't stop teens from buying online or in another town.

"It's like drinking," Bailey said. "People who want the products are going to be able to get the products. They just won't be getting them from responsible retailers."

But Levin said the move aims to protect the health of young people.

"As a child you need some guidance and some help in terms of what is this going to do for the rest of your life if you start smoking cigarettes now," Levin said. The new laws don't make it illegal to buy tobacco products, "it's simply raising the age of purchase."

The national Tobacco 21 campaign started after a town in Massachusetts raised the legal sales age from 21 and saw a sharp drop in teen smoking. A 2015 study from the Institute of Medicine found a nationwide policy could bring similar sharp cuts in youth initiation and overall smoking rates.

Meantime, other resort towns are considering whether to enact a Tobacco 21 ordinance. That includes Carbondale and Avon. Eagle County health coordinator Mandy Ivanov and intern Lilly Reynolds are talking with officials in both towns about the move.

Reynolds hoped their efforts will spark conversations, especially between teens and parents.

"If they raise the age then I'll probably at least bring awareness to the severity of the issue," Reynolds said.

To date, five states and more than 320 cities and counties have raised the legal sales age for tobacco from 18 to 21. Backers of Tobacco 21 say if enough localities sign on, they hope to take the effort statewide, adding Colorado to the list.

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colorado department of public health and environment (cdphe)

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Is Tobacco 21 The Solution To Colorado's Wave Of Teen Vaping?

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Colorado tops 37 other states for e-cigarette use among high school students, according to a national school-based survey by the Centers for Disease Control and Prevention. More than a quarter of Colorado high schoolers currently use e-cigarettes and almost 6 percent say they use them frequently.

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Wastewater can be used for irrigation though it may contain chemicals and promote water overuse. Countries are wanting to do this due to water shortages but there aren't many standards in place for testing this water and where it can be used.

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Countries facing growing water shortages are supplementing traditional fresh water with treated wastewater in the fields | David McNew/Getty Images

Using wastewater from toilets and showers to irrigate fields in parched Southern Europe is at the heart of the EU's circular economy plans.

Countries such as Spain, Italy and Greece are facing growing water shortages, in part due to climate change, so they're supplementing traditional fresh water with treated wastewater. A new European Commission proposal from May would set minimum requirements for water reuse, but countries would be able to also set their own higher standards.

Until the proposal becomes official, and it may not, governments can set their own laws regulating how farmers can use treated liquid waste.

But this circular solution may not be so perfect: There are worries that using wastewater for irrigation will harm already depleted rivers. And such water may host pollutants ranging from nitrates to microplastics and pharmaceuticals that are difficult and expensive to clean.

Brussels insists that its proposal will make using wastewater "safe and cost-effective," said Enrico Brivio, the Commission's spokesman on environmental issues.

Circle of life

The water used in toilets, showers, for dishes and laundry flows into treatment plants along with solid waste. The liquid is divided from solid matter and semi-solid sludge, treated to remove pollutants and nutrients such as phosphates and nitrates, and then disinfected to make it safe for reuse after which it is pumped to sprinkler systems on farms.

Instead of flowing back into rivers, treated water ends up on fields.

"You can have different quality of water dependent on the exposure from the water to products grown by farmers," said Bertrand Vallet, a policy officer on water services for EurEau, the water utilities lobby. "For example, apples grown using drip irrigation, or drops in soil, don't need the same level of quality as strawberries eaten raw by consumers."

Scientists say there is evidence that an increasing demand for treated urban wastewater is reducing the river levels in Europe's agricultural powerhouses such as Murcia in southern Spain.

"Murcia is one of the regions with the highest proportion of water reuse at close to 90 percent. It is reducing the circulating water flows in the Segura River," said Julia Martínez, executive director of the Foundation for a New Water Culture, a nonprofit run by scientists and academics pushing for more sustainable water management. "We need to ensure the Segura River is receiving an equivalent amount of the water that isn't coming back from the wastewater treatment plants."

Using wastewater may affect rivers, but it helps keep farmers from pumping underground aquifers dry. That's why reused water is cheap.

"If the water is expensive, the farmers aren't going to use it. They'll take surface water or groundwater that is then not available for drinking water because they need to irrigate their crops," Vallet said.

Commission spokesman Brivio said using wastewater from urban treatment plants helps the environment because it "extends the water life cycle, thereby helping to preserve water resources."

NGOs say recycling water this way isn't a long-term solution to the lack of rain. Rather than pumping more water, people should learn to use less.

"We aren't against water reuse but I think it is being framed in the wrong way," said David Sánchez, a campaign officer with Food & Water Europe. "It is another way to increase the water offer that is going to create more demand and not going to solve the problem it is supposed to solve, which is water scarcity."

Something in the water

Environmentalists also worry that using wastewater is risky because it could contain drugs and chemicals. According to the Commission's draft communication on pharmaceuticals in the environment, obtained by POLITICO, there are more than 3,000 drugs for sale in the EU, and some of them end up in wastewater after being used by people.

The document says synthetic estrogen, the main ingredient in contraceptive pills, in water has feminized male fish, making it harder for them to reproduce. And studies have found the painkiller diclofenac in fish and sea otters in Europe.

There has been no clear link between drug residues in the environment and direct impacts on humans. However, since it is more expensive to treat polluted water, it remains unclear who should pay to clean up medicine residues from waste water.

Brivio said that any food irrigated with reused water is safe because the Commission ensured that its proposal met rigorous health and environmental standards. EU countries such as Spain and Italy already have their own national standards to protect human health, such as grading the quality of the water and determining what kind of fruit and vegetables it can be used for. The EU wants to harmonize those rules.

He said all countries reusing water have to meet "the same minimum parameters, so as to secure a level of water quality which avoids any health or environmental risks."

The proposed regulation is now making its way through the European Parliament and Council of the EU. MEP Jan Huitema, shadow rapporteur for the ALDE group on the file, said water reuse could be a viable solution for parched areas.

"We have to guarantee safety for the environment and humans, but water scarcity is becoming more and more of a problem so we need to investigate this as a solution," Huitema said.

Back in Spain, Julia Martínez from the Foundation for a New Water Culture says the goal of the proposal shouldn't be to only to increase water supplies but it should also rethink how water is used and managed.

"As long as you are increasing the amount of water used, in the end, water stress is generally increased," she said.
This article is part of a series on the circular economy, Getting Wasted.

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Using wastewater on farms sparks environmental and health worries

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Using wastewater from toilets and showers to irrigate fields in parched Southern Europe is at the heart of the EU's circular economy plans. Countries such as Spain, Italy and Greece are facing growing water shortages, in part due to climate change, so they're supplementing traditional fresh water with treated wastewater.

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Sierra Svendsen - 7/1/18 - Non-infectious/Lifestyle diseases

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Sierra Svendsen - 7/1/18 - Non-infectious/Lifestyle diseases

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This article from NPR does a recent review of scientific studies that discuss whether artificial sweeteners actually help people lose weight. Artificial sweeteners are commonly used around the US but little is known about the advertised effect of weight loss.

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The theory behind artificial sweeteners is simple: If you use them instead of sugar, you get the joy of sweet-tasting beverages and foods without the downer of extra calories, potential weight gain and related health issues.

In practice, it's not so simple, as a review of the scientific evidence on non-nutritive sweeteners published Monday shows.

After looking at two types of scientific research, the authors conclude that there is no solid evidence that sweeteners like aspartame and sucralose help people manage their weight. And observational data suggest that the people who regularly consume these sweeteners are also more likely to develop future health problems, though those studies can't say those problems are caused by the sweeteners.

The health effects of artificial sweeteners are important to study, because so many people use them. Another study published earlier this year found that a quarter of U.S. children and 41 percent of adults reported consuming them, most of them once per day. Even more people may be consuming them unwittingly in products such as granola bars or yogurt.

"We were really interested in the everyday person who is consuming these products not to lose weight, but because they think it's the healthier choice, for many years on end," says Meghan Azad, lead author of the review and a research scientist at the University of Manitoba. While more research needs to be done, from what we know now, "there is no clear benefit for weight loss, and there's a potential association with increased weight gain, diabetes and other negative cardiovascular outcomes," says Azad.

The review, published Monday in the Canadian Medical Association Journal, looked at 37 studies. Seven of them were randomized trials, covering about 1,000 people, and the rest were observational studies that tracked the health and habits of almost 406,000 people over time.

Both types of studies have their pluses and limitations. In the seven trials, people were randomly assigned to receive the sweetener or not, allowing researchers to compare the two groups and say with some confidence whether the substance caused a benefit or harm. But because of the cost and effort involved, randomized trials are typically shorter term and don't include as many people.

They also may not reflect how people behave in the real world. Observational studies can track far more people for a much longer period, and they better reflect how people actually live. But the links they find between habits and health issues are associations, not direct evidence of cause and effect.

Most of the participants in the randomized trials were on a weight-loss program, and taken together, the results showed no significant impact of sweetener use on body mass index. The observational studies actually found a small increase in BMI associated with use of sweeteners, and a 14 percent higher chance of developing Type 2 diabetes for those who consumed the most artificial sweeteners compared to those who consumed the least (though there was a bias toward publishing studies that indicated a link, the authors noted). There was a 32 percent higher chance of cardiovascular events for the heaviest versus lightest users.

The Calorie Control Council, a trade group whose members include artificial sweetener manufacturers, notes that randomized trials have not confirmed those associations with diseases. It also says that obesity is complex, with many causes and requiring "personalized, multifactorial and multidisciplinary approaches using a variety of tools."

The available evidence suggests that sweeteners may help with weight loss if they are carefully used as a one-to-one replacement for sugar-sweetened drinks or foods as part of a structured weight-loss program, says Allison Sylvetsky Meni, an assistant professor in the department of exercise and nutrition sciences at George Washington University's Milken Institute School of Public Health. But that's not how they're typically used, she says. Sylvetsky Meni wasn't involved in this study, but was an author of the study on the prevalence of sweetener use.

There are a bunch of hypotheses for why artificial sweeteners may not promote weight loss or health. They may sharpen a sweet tooth, for example, prompting you to eat more sugary foods, or they may make you feel virtuous but then overcompensate later. Or the sweet taste paired with no calories may confuse the body and change how it handles real sugar, as has been shown in lab animals. Sweeteners may also alter the microbiome in ways that change metabolism for the worse.

Azad and Sylvetsky Meni say that much more research needs to be done, including looking specifically at different sweeteners rather than grouping them together. And more trials that reflect how people consume sweeteners in a host of foods are needed.

In the meantime, Azad thinks the lack of proven benefit and questions about harm should give pause to people who choose sweeteners because they think they're healthful substitutes for sugar. Sylvetsky Meni doesn't think having a diet soda here and there is bad. But that's a very different message than outright recommending sweeteners for weight loss or better health, she says.

And, she says, one option is to reduce your taste for sweet altogether rather than choosing between a sugar-sweetened or artificially sweetened drink or food. That means getting used to plain or fruit-infused water, black coffee and plain yogurt mixed with fruit rather than products containing either added sugars or artificial sweeteners.
Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson.

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Artificial Sweeteners Don't Help People Lose Weight, Review Finds

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The theory behind artificial sweeteners is simple: If you use them instead of sugar, you get the joy of sweet-tasting beverages and foods without the downer of extra calories, potential weight gain and related health issues. In practice, it's not so simple, as a review of the scientific evidence on non-nutritive sweeteners published Monday shows.

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Description:Jennifer Bourne, RGN Queens Nurse and Project Manager for FGM (Female Genital Mutilation)Prevention Programme, and Amanda O'Donovan, Consultant Clinical Pychologist, discuss the impact of FGM on mental health.