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A Brief But Spectacular take on the disability rights movement

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Full Episode: "The ADHD Explosion (Ep. 404)" | Our America with Lisa Ling | Oprah Winfrey Network

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The Supreme Court will hear a challenge to a Texas law that bans most abortions after as early as six weeks of pregnancy, the court said Friday.

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Rehab: Last Week Tonight with John Oliver (HBO)

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Body Dysmorphic Disorder (When the Mirror Lies)

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change the conversation

COVID-19 related closures have sent many of us to our home offices, kitchen counters, and dining tables for remote study or work - or none at all. For many, having to unexpectedly leave or disengage with our community - even if just for a short time - can be stressful. For others, this pandemic may be exacerbating symptoms of anxiety or other mental illnesses.

Active Minds is here for you .

Active Minds is the nation's premier nonprofit organization supporting mental health awareness and education for students.

Are you in crisis? Text BRAVE to 741-741 or call the Suicide Prevention Lifeline at 1-800-273-TALK for free, 24/7, and confidential support.

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Mental Health Amid the COVID-19 Crisis - Active Minds

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COVID-19 related closures have sent many of us to our home offices, kitchen counters, and dining tables for remote study or work - or none at all. For many, having to unexpectedly leave or disengage with our community - even if just for a short time - can be stressful.

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no spin, just the science of covid-19

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Coronavirus Is Our Future | Alanna Shaikh | TEDxSMU

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(no idea how much is out there on this topic- probably plenty??)

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Vaping was introduced into the US market as a tool for helping adult smokers quit. But that's not who has been buying e-cigarettes in mass.

The latest survey data on adolescent e-cigarette use, published this week in , shows another year-on-year surge in nicotine e-cigarette use among teens.

According to the survey findings, 28 percent of high school students reported using nicotine e-cigarettes in the past 30 days this year - up from just over 20 percent in 2018. Among middle schoolers, that rate rose from 5 percent in 2018 to 11 percent in 2019. The figures are "particularly concerning given relatively high exposure to nicotine through the use of nicotine salt-based e-cigarette products such as Juul," the researchers wrote, "which was the most commonly reported brand among youth using e-cigarettes in 2019."

The study, based on survey data from the National Youth Tobacco Survey from the Centers for Disease Control and Prevention, also found increases in the number of students reporting using menthol- or mint-flavored e-cigarettes, "to levels near that of fruit-flavored e-cigarettes."

Other recent studies have come to similarly alarming conclusions. Teen substance use survey data, published in the New England Journal of Medicine, recentlyfound that one in four 12th graders reported using nicotine e-cigarettes in the past 30 days. Among 10th graders, that rate is one in five, and among 8th graders, it's one in 11. Between 2017 and 2018, the same survey found the number of high school seniors who say they vaped nicotine in the past 30 days had doubled - from 11 percent to nearly 21 percent. That was the largest increase ever recorded in any substance in the survey's 43-year history. It was also the same year Juul, a device that was marketed at youth, took over the greatest share of the US e-cigarette market.

So, at a time when smoking cigarettes among youth was on its way out, adolescents as young as 13 have picked up a new nicotine device - the long-term health effects of which remain a mystery.

Meanwhile, another recent study shows e-cigarette use is staying stable or even declining in adults. Again, that's the group that was supposedly the intended target for e-cigarettes. Just 2 percent of adults ages 45 to 64 reported using e-cigarettes in 2018, according to the study. The number is even lower - 1 percent - for adults 65 and older.

The still mysterious vaping-related respiratory illness outbreak has sickened 2000 people - most of them young

The new youth survey data was released amid a vaping-related respiratory illness outbreak that's killed 39 people across the country and affected more than 2,000 patients.

Health officials don't know exactly what's causing the illness, but they do know that all patients reported using e-cigarette products, and the majority had vaped THC-containing devices.

Another fact is also clear: The outbreak is mostly affecting young people. More than half of patients are in their late teens and 20s, the CDC found.

The outbreak, together with the youth vaping data, prompted the White House to announce in September that it's planning to ban flavored e-cigarettes. Ahead of any federal action, Juul vowed to stop selling mint-flavored pods this week. In addition to the latest survey showing teens are increasingly using mint vapes, there's ample evidence that flavors are among the top draws to e-cigarettes for adolescents.

CDC advises youth to stop using e-cigarettes

For now, the CDC is advising everybody to avoid using THC e-cigarette products, particularly those purchased off the street. Certain groups - including youth and pregnant women - should not use any e-cigarette products, the agency says.

"At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases," the agency said in a statement, "and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products."

But even before the appearance of the mystery illness, researchers have been finding that vaping - while less dangerous than smoking - certainly isn't risk-free. Though it's long-term health effects remain unknown, it's already been tied to seizures, an increased risk in wheezing, and potential cardiovascular toxicity.

Recent studies have also shown that puffing on e-cigarettes increases concentration of these microscopic pollutants - in particular, PM2.5 and ultrafine particles - in indoor environments. Researchers don't yet know what risks e-cigarette aerosol particles carry, but these tiny particles have been studied extensively in the context of air pollution and tobacco smoking. In those studies, exposure to small particles has been linked with a range of bad cardiovascular outcomes, including heart attacks, high blood pressure, and coronary artery disease.

Further reading

Hear Vox senior health correspondent Julia Belluz explain the mysterious illness linked to vaping on this episode of the daily news podcast.

Looking for a quick way to keep up with the never-ending news cycle? Host Sean Rameswaram will guide you through the most important stories at the end of each day.

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Survey: the epidemic of teen vaping continues to surge, unabated

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Vaping was introduced into the US market as a tool for helping adult smokers quit. But that's not who has been buying e-cigarettes in mass. The latest survey data on adolescent e-cigarette use, published this week in , shows another year-on-year surge in nicotine e-cigarette use among teens.

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The country has experienced nursing shortages for decades, but an aging population means the problem is about to get much worse.

Joe Skipper / Reuters

Updated at 4:00 p.m. EST on February 12, 2016

Five years ago, my mother was rushed to the hospital for an aneurysm. For the next two weeks, my family and I sat huddled around her bed in the intensive-care unit, oscillating between panic, fear, uncertainty, and exhaustion.

It was nurses that got us through that time with our sanity intact. Nurses checked on my mother-and us-multiple times an hour. They ran tests, updated charts, and changed IVs; they made us laugh, allayed our concerns, and thought about our comfort. The doctors came in every now and then, but the calm dedication of the nurses was what kept us together. Without them, we would have fallen apart.

Which is just one reason why the prospect of a national nursing shortage is so alarming. The U.S. has been dealing with a nursing deficit of varying degrees for decades, but today-due to an aging population, the rising incidence of chronic disease, an aging nursing workforce, and the limited capacity of nursing schools-this shortage is on the cusp of becoming a crisis, one with worrying implications for patients and health-care providers alike.

America's 3 million nurses make up the largest segment of the health-care workforce in the U.S., and nursing is currently one of the fastest-growing occupations in the country. Despite that growth, demand is outpacing supply. According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022.* By 2025, the shortfall is expected to be "more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s," a team of Vanderbilt University nursing researchers wrote in a 2009 paper on the issue.

The primary driving force in this looming crisis is the aging of the Baby Boomer generation: Today, there are more Americans over the age of 65 than at any other time in U.S. history. Between 2010 and 2030, the population of senior citizens will increase by 75 percent to 69 million, meaning one in five Americans will be a senior citizen; in 2050, an estimated 88.5 million people in the U.S. will be aged 65 and older.

And as the population ages, demand for health-care services will soar. About 80 percent of older adults have at least one chronic condition, and 68 percent have at least two, according to the National Council on Aging. A USA Today analysis of Medicare data revealed that two-thirds of traditional Medicare beneficiaries older than 65 have multiple chronic conditions, a number that will only continue to climb.

"People with chronic diseases clearly use more health-care services, and people who are older have more chronic disease," said Julie Sochalski, an associate professor at the University of Pennsylvania School of Nursing. "The aging population and chronic disease are creating the perfect storm driving demand for nurses."

But swelling demand is only part of the problem. Like the patients they serve, the country's nurses are also aging. Around a million registered nurses (RNs) are currently older than 50, meaning one-third of the current nursing workforce will reach retirement age in the next 10 to 15 years. Nearly 700,000 nurses are projected to retire or leave the labor force by 2024.*

"The biggest cohort of registered nurses joined the workforce before the 1970s," when career choices for women were more limited, said Pam Cipriano, the president of the American Nurses Association (nursing is still overwhelmingly female). As a result, the field now skews older.

"Many nurses held off retiring during the downturn in the economy, she added, "but now the retirements are starting."

But filling the vacancies left by retiring nurses isn't a simple one-for-one proposition. Nearly 155,000 new nursing graduates entered the workforce in 2015.* While the number of new nursing students and graduates is growing, the nursing-education system hasn't kept pace, effectively creating a bottleneck in which only so many aspiring nurses can access the training they need. According to an American Association of Colleges of Nursing report, "U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints." Once again, aging is a factor: Many nursing faculty members are approaching retirement, but without them, nursing schools can't expand their cohorts.

"As those numbers [of nurse educators] drop, schools have to maintain critical student- to-teacher ratios," Cipriano said. "Preparation for most nurse faculty is a doctoral degree, and you can't just replace someone in that position. The trajectory of timeline to fill jobs that nurse faculty are retiring from is much longer."

In many areas, the barrier to entry isn't nursing school, but the training that comes afterwards. Sochalski said that where she works in Philadelphia, there are a handful of nursing schools, but a limited number of hospitals and clinics, meaning a limited number of clinical places where fledgling nurses can gain practical experience.

Many health-care providers also shy away from recruiting these newer nurses, Cipriano explained. "When we think about nurses replacing retiring nurses, there is an experience gap," she said. "People like me who have 40 years of experience will be replaced by individuals with three to five years of experience. Employers need to focus on the fact that they have a responsibility and a burden to ensure that new nurses can maintain expertise and wisdom at a patient's side."

* * *

It seems as though every expert, group, or academic study has a different take on just how dire the nursing shortage will become. Ed Salsberg, a researcher at the George Washington University School of Nursing who studies nursing-workforce issues, said the country's evolving health-care system is one variable that may affect projections.

"The health-care delivery system has put in a lot of effort to make the system more efficient and effective, to reduce unnecessary use of health-care services and reduce hospital readmissions," Salsburg said. "We don't know for sure whether this is going to increase or decrease demand for nurses. It's one of the big questions as we look towards the future." Thus far, he explained, the Affordable Care Act has not contributed significantly to the rising demand for nursing services, because most people newly insured under the ACA skew young and healthy.

To Salsburg, America is not facing a national nursing shortage so much as grappling with a "problem of distribution"-some health-care markets in the U.S. have a plentiful supply of nurses, with other regions feeling the scarcity more acutely.

In a 2012 paper titled " United States Registered Nurse Workforce Report Card and Shortage Forecast," researchers forecasted RN job shortages in each state and assigned a letter grade accordingly. They predicted that the number of states meeting the criteria for a "D" or "F" will increase from five in 2009 to 30 by 2030. All 12 states projected to receive an F are in the South and the West: Florida, Georgia, Texas, Virginia, Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, and New Mexico.

Vernon Lin, one of the authors of this study and a professor at the Cleveland Clinic Lerner College of Medicine, said he has experienced the nursing shortage throughout his career, across states and healthcare systems.

"When I was working in Long Beach, we had over 20 nursing vacancies at any one time. And this was in sunny southern California, close to the beach, for a job with federal-government benefits," Lin said. "I began to look into the situation and, lo and behold, for the past 20 to 30 years, California has only produced 50 percent of the nurses it needed."

Like unhappy families, each shortage pocket is unique. In states like Florida and Arizona, the aging population is the real culprit; in other states, the gap is largely due to a limited number of nurse-education opportunities. Lin said that nursing supply is "mostly local," meaning nurses tend to stay in the same markets where they go to school. Fewer schools means fewer nurses. Unsurprisingly, rural and poorer areas have a harder time recruiting nurses than urban magnet hospitals, which can offer higher-paying jobs and lifestyle perks.

The Rapid City Regional Hospital in South Dakota recently began closing beds due to a shortage of experienced RNs. Lori Wightman, the newly hired chief of nursing for the Regional Health System, said the number of closed beds at RCRH adjusts day to day, based on the number of nurses available for each shift.

"Closing beds really is a last resort," Wightman said. "The first thing we have to consider is patient safety. There are standards of practice for what nurse-to-patient ratios should be."

Those standards can represent the difference between life and death. When nurses are stretched too thin, they have less time and energy to devote to each patient. Overworking leads to fatigue and burnout, which threatens the quality of care and increases the incidence of error. Past research has found links between insufficient nursing staffing and higher rates of hospital readmission and patient mortality. Higher patient loads are also linked to higher rates of nurse turnover, which can costly, disruptive, and potentially harmful to patient safety. Conversely, more and happier nurses can mean better care and better outcomes.

When facing a nursing shortage, hospitals have a handful of options beyond closing beds. They can ask their nurses to work more hours or offer financial incentives for those who pick up extra shifts, though for the reasons outlined above, this may not be a safe option. Many hospitals offer financial incentives to nurses who work additional shifts. Some companies also rely on temporary "travel nurses" who typically work for around 13 weeks at a time, but they come at a premium.

"Now nurses can move all over the country because of demand, and our job is to show them what a great place [South Dakota] is to work," Wightman said.

Beyond a good salary, strong cultural fit, flexible hours, and manageable expectations, Wightman said nurses also want to work in places where they can practice to the full scope of their license. Each state has different guidelines for what each type of license allows a nurse to do. For example, nurse practitioners are more limited in in South Dakota than in some neighboring states, and may choose not to take a job in South Dakota as a result. Wightman said national licensure for nurses, Wightman believes, would make it easier to address deficits.

Another long-term strategy is to open up the paths to a degree. In the Institute of Medicine's "The Future of Nursing" report, the authors recommended that nurses should achieve higher levels of education and training, and called for the proportion of nurses with baccalaureate degrees to increase to 80 percent by 2020. While it would seem that more highly educated nurses is something to strive for, Salsburg said this could potentially exacerbate shortages. Many aspiring nurses, particularly those in rural and poorer areas, enter the field with an associate's degree and pursue an advanced degree later. Given that nurses tend to stay local, providing viable educational opportunities in these communities is key.

"We don't want to cut off access to education in rural communities where, in many cases, an associate's degree in nursing is the only local nursing education opportunity," Salsburg said. "The associate's degree has to be seen as a pathway to nursing."

Other strategies to address the nursing shortage have included public-private partnerships and incentives for nurses to become nurse educators. Johnson & Johnson recently launched the Campaign for Nursing's Future, an effort that uses TV commercials, videos, a website, and brochures to tout the benefits of "this rich and rewarding career." And two years ago, the University of Wisconsin (UW) announced the $3.2 million initiative to provide fellowships and loan forgiveness for nurses who agree to teach in the state after graduation from nursing school.

Cipriano said the American Nurses Association is currently lobbying Congress to increase funding for Title VIII of the Public Health Service Act. The provision allots federal grants for nursing schools and organizations to advance their educational programs, promote diversity in the field, repay loans for nursing students who work in facilities with critical shortages, train geriatric nurses, and more.

"We saw this money reduced by $2.15 million this year, and when you adjust for inflation, we've seen a 30 percent decline in that money since 1971," she said. "To maintain our supply and the pipeline, Title VIII is critical." But even as the threat of a more severe shortage looms, an increase in funding remains uncertain. The only certainty, in fact, is this: There will always be a need for nurses, the medical professionals that make otherwise harrowing experiences bearable for patients and their families.
* This article has been updated to reflect the latest data on U.S. nursing shortages provided by the American Nursing Association.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Rebecca Grant is a freelance writer based in New York. She covers technology in emerging markets and diversity in the tech industry.

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The country has experienced nursing shortages for decades, but an aging population means the problem is about to get much worse. Updated at 4:00 p.m. EST on February 12, 2016 Five years ago, my mother was rushed to the hospital for an aneurysm.

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A Social Experiment on Mental Health Stigma | Beyond the Label

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Studies show that noise has a powerful physical effect on our brains, causing elevated levels of stress hormones.

The Proof that Noise Hurts and Silence Heals

The value of silence is felt by everyone at some point in their life. Silence is comforting, nourishing and cosy. It opens us up to inspiration, and nurtures the mind, body and soul. Meanwhile, the madness of the noisy world is drowning out our creativity, our inner connection and hampering our resilience. Science is now showing that silence may be just what we need to regenerate our exhausted brains and bodies.

Studies show that noise has a powerful physical effect on our brains, causing elevated levels of stress hormones. Sound travels to the brain as electrical signals via the ear. Even when we are sleeping these sound waves cause the body to react and activate the amygdala, the part of the brain associated with memory and emotion, leading to the release of stress hormones. So, living in a consistently noisy environment will cause you to experience extremely high levels of these harmful hormones.

Interestingly, the word noise is said to come from the Latin word nausia, (disgust or nausea) or the Latin word noxia, meaning hurt, damage or injury. Noise has been linked to high blood pressure, heart disease, tinnitus and loss of sleep. We've all experienced the detrimental effects of noise pollution. Excessive noise can be a major affront to the physical senses and today, more and more people are identifying as highly sensitive and unable to function in chaotic and noisy environments. But now science has the proof not only that noise hurts, but also that silence heals.
Studies show that noise causes stress hormones to be released in the brain.
The Effects of Silence

In 2011, the World Health Organisation (WHO) examined and quantified its health burden in Europe. It concluded that the 340 million residents of Western Europe (about the population of the United States), were losing a million years of healthy life every year, due to noise. WHO also said that the root cause of 3,000 heart disease deaths was due to excessive noise. A study by Professor Gary W. Evans from Cornell University, published in Psychological Science, charted the effects of airport noise on school children near Munich's airport. The study showed that children exposed to noise developed a stress response which actually caused them to ignore the noise. He found that the children ignored both the harmful noise of the airport, along with other more everyday noises, such as speech.

This study is among the strongest, probably the most definitive proof that noise-even at levels that do not produce any hearing damage-causes stress and is harmful to humans. - Professor Gary Evans.

Scientists didn't actively set out to study the effects of silence, but instead discovered its benefits by accident. Silence first began to appear in scientific research as a control or baseline, against which scientists compare the effects of noise or music. Physician Luciano Bernardi studied the physiological effects of noise and music in 2006, making a startling discovery. When the subjects of his study were exposed to the random stretches of silence in between the noise and music, they experienced a powerful effect. The two minute pauses were far more relaxing for the brain than the relaxing music or the longer silence that was in place before the experiment started. In fact, Bernardi's 'irrelevant' blank pauses became the most important aspect of the study. One of his key findings was that silence is heightened by contrasts.

The brain recognises silence and responds powerfully.

Many meditation teachers and practitioners can attest to this, and spiritual teachers advise students to take frequent meditative pauses throughout the day. Though we may think of silence as a lack of input, science says otherwise. The brain recognises silence and responds powerfully. Later research by a Duke University regenerative biologist, Imke Kirste, discovered that two hours of silence per day prompted cell development in the hippocampus, the brain region related to the formation of memory, involving the senses.

Taking Time to Switch Off

According to the Attention Restoration Theory, when you are in an environment with lower levels of sensory input, the brain can 'recover' some of its cognitive abilities. With our digital world, our brains get less time to switch off. We are constantly processing enormous amounts of information. Research has shown the constant attention demands of modern life is placing a lot of stress on our prefrontal cortex-the part of the brain responsible for making decisions, solving problems and more. When we spend time alone in silence, our brains are able to relax and release this constant focus.

Researchers found that silence helps new cells to differentiate into neurons, and integrate into the system, and that when we experience silence, our brains are able to work at better understanding our internal and external environments. We can make sense of our lives and gain perspective, something that is vital for our overall wellbeing.

Silence relieves stress and tension in the brain and body.
While noise creates stress, silence relieves stress and tension in the brain and body. Silence is replenishing and nourishes our cognitive resources. Noise makes us lose our concentration, cognitive powers and causes decreased motivation and brain functioning (as backed up by research into the effects of noise), but studies show that spending some time in silence can amazingly restore what was lost through exposure to excessive noise. The ancient spiritual masters have known this all along; silence heals, silence takes us deeply into ourselves, and silence balances the body and mind. Now science is saying the same thing.

The healing benefits of nature and stillness are well documented, but now we can add to this quest for health and wellbeing, the nourishment of our brains. The simple yet ancient experience of silence could be just the healing balm we need to quell our crazy modern lifestyle.

Silence is an empty space. Space is the home of the awakened mind. - Buddha

By Azriel ReShel

This articles is republished with kind permission from upliftconnect.com

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Science Says Silence is Vital for Our Brains

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Studies show that noise has a powerful physical effect on our brains, causing elevated levels of stress hormones. The value of silence is felt by everyone at some point in their life. Silence is comforting, nourishing and cosy. It opens us up to inspiration, and nurtures the mind, body and soul.

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The Bleeding Edge | Trailer [HD] | Netflix

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These powerful talks offer ideas for rethinking-and hopefully stopping-the spread of HIV and AIDS.

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The Trade: The Trade Official Trailer | SHOWTIME

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The Trade spotlights the crisis through the eyes of those most affected: the growers, addicts, cartel bosses and law enforcement hopelessly caught in its web. THE TRADE will world premiere at the 2018 Sundance Film Festival and debut on Friday, February 2 at 9 p.m. ET/PT on SHOWTIME.

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On a melancholy Saturday this past February, Shalon Irving's "village" - the friends and family she had assembled to support her as a single mother - gathered at a funeral home in a prosperous black neighborhood in southwest Atlanta to say goodbye.

The afternoon light was gray but bright, flooding through tall, arched windows and pouring past white columns, illuminating the flag that covered her casket. Sprays of callas and roses dotted the room like giant corsages, flanking photos from happier times: Shalon in a slinky maternity dress, sprawled across her couch with her puppy; Shalon, sleepy-eyed and cradling the tiny head of her newborn daughter, Soleil. In one portrait, Shalon wore a vibrant smile and the crisp uniform of the Commissioned Corps of the U.S. Public Health Service, where she had been a lieutenant commander. Many of the mourners were similarly attired. Shalon's father, Samuel, surveyed the rows of somber faces from the lectern. "I've never been in a room with so many doctors," he marveled. "... I've never seen so many Ph.D.s."

At 36, Shalon had been part of their elite ranks - an epidemiologist at the Centers for Disease Control and Prevention, the pre-eminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick. "She wanted to expose how people's limited health options were leading to poor health outcomes," said Rashid Njai, her mentor at the agency. "To kind of uncover and undo the victim-blaming that sometimes happens where it's like, 'Poor people don't care about their health.' " Her Twitter bio declared: "I see inequity wherever it exists, call it by name, and work to eliminate it."

Much of Shalon's research had focused on how childhood experiences affect health later on - examining how kids' lives went off track, searching for ways to make them more resilient. Her discovery in mid-2016 that she was pregnant with her first child had been unexpected and thrilling.

Then the unthinkable happened. Three weeks after giving birth, Shalon collapsed and died from complications of high blood pressure.

The researcher working to eradicate disparities in health access and outcomes had become a symbol of one of the most troublesome health disparities facing black women in the U.S. today: disproportionately high rates of maternal mortality. The main federal agency seeking to understand why so many American women - especially black women - die, or nearly die from complications of pregnancy and childbirth had lost one of its own.

Even Shalon's many advantages - her B.A. in sociology, her two master's degrees and dual-subject Ph.D., her gold-plated insurance and rock-solid support system - had not been enough to ensure her survival. If a village this powerful hadn't been able to protect her, was any black woman safe?

The sadness in the chapel was crushing. Shalon's long-divorced parents had already buried both their sons; she had been their last remaining child. Wanda Irving had been especially close to her daughter - role model, traveling companion, emotional touchstone. She sat in the front row in a black suit and veiled hat, her face a portrait of unfathomable grief. Sometimes she held Soleil, fussing with her pink blanket. Sometimes Samuel held Soleil, or one of Shalon's friends.

A few of Shalon's villagers rose to pay tribute; others sat quietly, poring through their funeral programs. Daniel Sellers, Shalon's cousin from Ohio and the baby's godfather, spoke for all of them when he promised Wanda that she would not have to raise her only grandchild alone.

"People say to me, 'She won't know her mother.' That's not true," Sellers said. "Her mother is in each and every one of you, each and every one of us. ... This child is a gift to us. When you remember this child, you remember the love that God has pushed down through her for all of us. Soleil is our gift."

The memorial service drew to a close, the bugle strains of taps as plaintive as a howl. Two members of the U.S. Honor Guard removed the flag from Shalon's coffin and held it aloft. Then they folded it into a precise triangle small enough for Wanda and Samuel to hold next to their hearts.

Racial disparity across incomes

In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.

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That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; in 2001-2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks.

The disproportionate toll on African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, the World Health Organization estimates.

What's more, even relatively well-off black women like Shalon Irving die and nearly die at higher rates than whites. Again, New York City offers a startling example: A 2016 analysis of five years of data found that black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.

The fact that someone with Shalon's social and economic advantages is at higher risk highlights how profound the inequities really are, said Raegan McDonald-Mosley, the chief medical director for Planned Parenthood Federation of America, who met her in graduate school at Johns Hopkins University and was one of her closest friends. "It tells you that you can't educate your way out of this problem. You can't health care-access your way out of this problem. There's something inherently wrong with the system that's not valuing the lives of black women equally to white women."

For much of American history, these types of disparities were largely blamed on blacks' supposed susceptibility to illness - their "mass of imperfections," as one doctor wrote in 1903 - and their own behavior. But now many social scientists and medical researchers agree, the problem isn't race but racism.

The systemic problems start with the type of social inequities that Shalon studied - differing access to healthy food and safe drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation.

Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.

Those problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme.

There was the new mother in Nebraska with a history of hypertension who couldn't get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor's attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke.

Over and over, black women told of medical providers who equated being African-American with being poor, uneducated, noncompliant and unworthy. "Sometimes you just know in your bones when someone feels contempt for you based on your race," said one Brooklyn, N.Y., woman who took to bringing her white husband or in-laws to every prenatal visit. Hakima Payne, a mother of nine in Kansas City, Mo., who used to be a labor and delivery nurse and still attends births as a midwife-doula, has seen this cultural divide as both patient and caregiver. "The nursing culture is white, middle-class and female, so is largely built around that identity. Anything that doesn't fit that identity is suspect," she said. Payne, who lectures on unconscious bias for professional organizations, recalled "the conversations that took place behind the nurse's station that just made assumptions; a lot of victim-blaming - 'If those people would only do blah, blah, blah, things would be different.' "

In a survey conducted this year by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 33 percent of black women said that they personally had been discriminated against because of their race when going to a doctor or health clinic, and 21 percent said they have avoided going to a doctor or seeking health care out of concern they would be racially discriminated against.

Black expectant and new mothers frequently said that doctors and nurses didn't take their pain seriously - a phenomenon borne out by numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer. When Patrisse Cullors, a co-founder of the Black Lives Matter movement who has become an activist to improve black maternal care, had an emergency C-section in Los Angeles in March 2016, the surgeon "never explained what he was doing to me," she said. The pain medication didn't work: "My mother basically had to scream at the doctors to give me the proper pain meds."

But it's the discrimination that black women experience in the rest of their lives - the double whammy of race and gender - that may ultimately be the most significant factor in poor maternal outcomes.

"It's chronic stress that just happens all the time - there is never a period where there's rest from it. It's everywhere; it's in the air; it's just affecting everything," said Fleda Mask Jackson, an Atlanta researcher who focuses on birth outcomes for middle-class black women.

It's a type of stress for which education and class provide no protection. "When you interview these doctors and lawyers and business executives, when you interview African-American college graduates, it's not like their lives have been a walk in the park," said Michael Lu, a longtime disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration, the main federal agency funding programs for mothers and infants. "It's the experience of having to work harder than anybody else just to get equal pay and equal respect. It's being followed around when you're shopping at a nice store, or being stopped by the police when you're driving in a nice neighborhood."

An expanding field of research shows that the stress of being a black woman in American society can take a physical toll during pregnancy and childbirth.
Chronic stress "puts the body into overdrive," Lu said. "It's the same idea as if you keep gunning the engine, that sooner or later you're going to wear out the engine."

As women get older, birth outcomes get worse. ... If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s.

Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term "weathering" for stress-induced wear and tear on the body. Weathering "causes a lot of different health vulnerabilities and increases susceptibility to infection," she said, "but also early onset of chronic diseases, in particular, hypertension and diabetes" - conditions that disproportionately affect blacks at much younger ages than whites. Her research even suggests it accelerates aging at the molecular level; in a 2010 study Geronimus and colleagues conducted, the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.

Weathering has profound implications for pregnancy, the most physiologically complex and emotionally vulnerable time in a woman's life. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday). Here again, income and education aren't protective.

The repercussions for the mother's health are also far-reaching. Maternal age is an important risk factor for many severe complications, including pre-eclampsia, or pregnancy-induced hypertension. "As women get older, birth outcomes get worse," Lu said. "If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s."

This means that for black women, the risks for pregnancy start at an earlier age than many clinicians - and women- realize, and the effects on their bodies may be much greater than for white women. In Geronimus' view, "a black woman of any social class, as early as her mid-20s should be attended to differently."

That's a concept that professional organizations and providers have barely begun to wrap their heads around. "There may be individual doctors or hospitals that are doing it [accounting for the higher risk of black women], but ... there's not much of that going on," Lu said. Should doctors and clinicians be taking into account this added layer of vulnerability? "Yeah," Lu said. "I truly think they should."

A high-pressure life

Shalon Irving's history is almost a textbook example of the kinds of strains and stresses that make high-achieving black women vulnerable to poor health. The child of two Dartmouth graduates, she grew up in Portland, Ore., where her father's father was pastor of a black church. Even in its current liberal incarnation, Portland is one of the whitest large cities in the U.S., in part a vestige of the state's founding by Confederate sympathizers who wrote exclusion of blacks into their constitution.

Thirty years ago, Portland was a much more uncomfortable place to be black. African-American life there was often characterized by social isolation, which Geronimus' research has shown to be especially stressful. Her father, Samuel Irving, spent years working for the railroad and later for the city but felt his prospects were limited by his race. Her mother, Wanda Irving, held various jobs in marketing and communications, including at the U.S. Forest Service. In elementary school, Shalon was sometimes the only African-American child in her class. "There were many mornings where she would stand outside banging on the door wanting to come back into the house because she didn't want to go to school," her mother recently recalled.

Shalon's strategy for fitting in was to be smarter than everyone else. She read voraciously, wrote a column for a black-owned weekly newspaper, and skipped a grade. Books and writing helped her cope with trauma and sorrow - first the death of her 20-month-old brother Simone in a car accident when she was 6, then the fracturing of her parents' marriage, then the diagnosis of her beloved older brother, Sam III, with a virulent form of early-onset multiple sclerosis when he was 17. Amid all the family troubles, Shalon was funny and driven, with a fierce sense of loyalty and "a moral compass that was amazing," her mother said.

She was also overweight and often anxious, given to daydreaming (as she later put it) about "alternative realities where people hadn't died and things had not been lost." When it came time to go away to college, she chose the historically black Hampton University in Virginia. "She wanted to feel that nurturing environment," Wanda said. "She had had enough."

By then, Shalon had noticed that many of her relatives -her mother's mother, her aunts, her far-flung cousins - had died in their 30s and 40s. Her brother Sam III sardonically joked that the family had a "death gene," but Shalon didn't think that was funny. "She didn't understand why there was such a disparity with other families that had all these long lives," Wanda said. Shalon nagged her father to stop smoking and her mother to lose weight. She set an example, shedding nearly 100 pounds while managing to graduate summa cum laude. At the start of graduate school at Purdue University, she was a svelte 138 pounds, "very classy and elegant, a lot like her mom," said Bianca Pryor, a master's student in consumer behavior who became one of her closest friends.

West Lafayette, Ind., felt as white as Portland. For support, Shalon relied on a cherished circle of "sister friends," as she called them. "There's this feeling that we're carrying the expectations of generations, the first ones trying to climb the corporate ladder, trying to climb in academe," Pryor said. "There is this idea that we have to work twice as hard as everyone else. But there's also, 'I'm first-generation; I don't know the ropes; I don't how to use my social capital.' There's a bit of shame in that ... this constant checking in with yourself - am I doing this right?"

Much of Shalon's pressure was self-imposed: She was pursuing a double Ph.D. in sociology and gerontology, focusing on themes she would return to often - the long-term effects of early-childhood trauma and maltreatment, the impact of the parent-child relationship on lifelong health. She finished in under five years, once again with highest honors - "one of the best writers I've had in my academic career," her adviser, sociologist Kenneth Ferraro, said.

Next, Shalon decided to pursue a second master's degree, this time from Johns Hopkins. She was also juggling family responsibilities. Wanda had followed Shalon around the country, working in nonprofit management. "They were like the Gilmore Girls," Pryor said. In 2008, Sam III joined them in Baltimore to take part in a study for an experimental MS therapy. With his family's support, he had managed to finish college and run a poetry-slam nonprofit for kids. His next goal was to walk across the stage to receive his diploma instead of using his wheelchair. In February 2009, while he was doing physical rehab to regain strength in his legs, a blood clot traveled to his lung, killing him at the age of 32. Afterward, Wanda and Shalon clung to each other more tightly than ever.

What Shalon wasn't prepared for was how unfulfilled she was. After Johns Hopkins, she had worked on the front lines helping at-risk infants, teenage girls, and mothers with HIV/AIDS. She was passionate about improving food and housing security to reduce people's risk for high blood pressure and other cardiovascular problems. At the CDC, it bothered her that she rarely met the people behind the data she was analyzing. As a consultant for Michelle Obama's anti-obesity initiative Let's Move! "she might see the numbers, but I don't think she actually saw that little girl or little boy have a healthier lunch," Pryor said.

The stress and frustration triggered the old corrosive self-doubts. But gradually, Shalon saw a way out of the box. She joined the CDC's Division of Violence Prevention, refocusing on issues around trauma and domestic abuse - a mission she saw as "liberating" for African-American women, Wanda said. She started a coaching business called Inclusivity Standard to advise young people from disadvantaged backgrounds who wanted to get into college or grad school and organizations seeking to become more diverse. And she decided to write a self-help book, on the theory that many people in the communities she cared about couldn't afford psychotherapy or didn't trust it. "She was one of those people - one thing is just not enough," said her co-author, Habiba Tran, a therapist and life coach with a multicultural clientele. "One modality is just not enough. One way of [reaching people] is just not enough."

Becoming a mother

Shalon couldn't remember a time when she didn't want to be a mother. But her romantic life had been a "20-year dating debacle," she admitted in the manuscript of her self-help book, in part because "I am deathly scared of heartbreak and disappointment, and letting people in comes with the very real risk of both."

In 2014, when Shalon was 34, medical problems forced the issue. For years she had been suffering from uterine fibroids - nonmalignant tumors that affect up to 80 percent of black women, leading to heavy menstrual bleeding, anemia and pelvic pain. No one knows what causes fibroids or why blacks are so susceptible. What is known is that the tumors can interfere with fertility - indeed, black women are nearly twice as likely to have infertility problems as whites, and when they undergo treatment, there's much less likelihood that the treatments will succeed. Surgery bought her a little time, but her OB/GYN urged her not to delay getting pregnant much longer.

Shalon had spent her adult years defying stereotypes about black women; now she wrestled with the reality that by embracing single motherhood, she could become one. The financial risk was substantial - she had just purchased a town house in the quiet Sandy Springs area north of Atlanta, and her CDC insurance covered artificial insemination only for wives using their husbands' sperm. In Portland, no one would have blinked an eye at an unmarried professional woman having a child on her own, but in Atlanta, "there is very much a vibe there that things should happen in a certain order," Pryor said. "And Shalon was not having that at all. She was like, 'Nope, this is what it is.' "

The gamble - funded with her parents' help - ended in a series of devastating failures. In September 2015, in the midst of an unsuccessful fertility treatment, Shalon was alarmed to discover that her right arm had become swollen and hard. Doctors found a blood clot and diagnosed her with Factor V Leiden, a genetic mutation that makes blood prone to abnormal clumping. Suddenly a part of the family's medical mystery was solved. Wanda's mother had died of a pulmonary embolism; so had Sam III; so had other members of their extended family. But no one had been tested for the mutation, which is primarily associated with European ancestry. Had they known they carried it, maybe Sam's deadly blood clot could have been prevented. It was a what-if too painful to dwell on.

By April 2016, Shalon had given up. She had a new boyfriend and was on her way to Puerto Rico to help with the CDC'S Zika response, working to prevent the spread of the virus to expectant mothers and their unborn babies. There, she discovered she'd gotten pregnant by accident. Her excitement was tempered by fear that the baby might have contracted Zika, which can cause microcephaly and other birth defects. But a barrage of medical tests confirmed all was well.

More good news: A few weeks later, her friend Pryor learned she was pregnant, too. "All right," she told Shalon, "let's finally go after our rainbows and unicorns! Because for so long it was just dark clouds and rain."

In reality, Shalon's many risk factors - including her clotting disorder, her fibroid surgery, the 36 years of wear and tear on her telomeres, her weight - boded a challenging nine months. She also had a history of high blood pressure, though it was now under control without medication. "If I was the doctor taking care of her, I'd be like, 'Oh, this is going to be a tough one,' " her OB/GYN friend McDonald-Mosley said.

Shalon got through the physical challenges surprisingly well. Her team at Emory University, one of the premier health systems in the South, had no trouble managing her clotting disorder with the blood thinner Lovenox. They worried that scarring from the fibroid surgery could result in a rupture if her uterus stretched too much, so they scheduled a C-section at 37 weeks. At several points, Shalon's blood pressure did spike, Wanda said, but doctors ruled out pre-eclampsia and the numbers always fell back to normal.

Wanda blamed stress. There was the painful end to Shalon's romance with her baby's father and her dashed hopes of raising their child together. There were worries about money and panic attacks about the difficulties of being a black single mother in the South in the era of Trayvon Martin and Tamir Rice. Shalon told everyone she was hoping for a girl.

Steeped in research about how social support could buffer against stress and adversity, Shalon joined online groups for single mothers and assembled a stalwart community she could quickly deploy for help. "She was all about the village," Njai, her CDC mentor, said. "She'd say, 'I'm making sure that when I have my baby, the village is activated and ready to go.' "

She poured more of her anxious energy into finishing the first draft of the book. She sent Tran the manuscript on Jan. 2, the day before the planned C-section, then typed one last note to her child. Boy or girl, its nickname would be Sunny, in honor of her brother Sam, her "sunshine." "You will always be my most important accomplishment," she wrote. "No words have been created to adequately capture the fear and love and excitement that I feel right now."

Sporadic postpartum care

Until recently, much of the discussion about maternal mortality has focused on pregnancy and childbirth. But according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For American women in general, postpartum care can be dangerously inadequate - often no more than a single appointment four to six weeks after going home.

"If you've had a cesarean delivery, if you've had pre-eclampsia, if you've had gestational diabetes or diabetes, if you go home on an anticoagulant - all those women need to be seen significantly sooner than six weeks," said Haywood Brown, a professor at Duke University medical school. Brown has made reforming postpartum care one of his main initiatives as president of the American Congress of Obstetricians and Gynecologists.

The dangers of sporadic postpartum care may be particularly great for black mothers. African-Americans have higher rates of C-section and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They have disproportionate rates of hypertensive disorders and peripartum cardiomyopathy (pregnancy-induced heart failure), two leading killers in the days and weeks after delivery. They're twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment.

If they experience discrimination or disrespect during pregnancy or childbirth, they are more likelyto skip postpartum visits to check on their own health (they do keep pediatrician appointments for their babies). In one study published earlier this year, two-thirds of low-income black women never made it to their doctor visit.

Meanwhile, many providers wrongly assume that the risks end when the baby is born - and that women who came through pregnancy and delivery without problems will stay healthy. In the case of black women, providers may not understand their true biological risks or evaluate those risks in a big-picture way. "The maternal experience isn't over right at delivery. All of the due diligence that gets applied during the prenatal period needs to continue into the postpartum period," said Eleni Tsigas, executive director of the Preeclampsia Foundation.

All of the due diligence that gets applied during the prenatal period needs to continue into the postpartum period.

It's not just doctors and nurses who need to think differently. Like a lot of expectant mothers, Shalon had an elaborate plan for how she wanted to give birth, even including what she wanted her surgical team to talk about (nothing political) and who would announce the baby's gender (her mother, not a doctor or nurse). But like most pregnant women, she didn't have a postpartum care plan. "It was just trusting in the system that things were gonna go OK," Wanda said. "And that if something came up, she'd be able to handle it."

The birth was "a beautiful time," Wanda said. Shalon did so well that she persuaded her doctor to let her and Soleil - French for "sun" - leave the hospital after two nights (three or four nights are more typical). Then at home, "things got real," Pryor said. "It was Shalon and her mom trying to figure things out, and the late nights, and trying to get baby on schedule. Shalon was very honest. She told me, 'Friend, this is hard.' "

C-sections have much higher complication rates than vaginal births. In Shalon's case, the trouble - a painful lump on her incision - started a week after she went home. The first doctor she saw, on Jan. 12, said it was nothing, but as she and her mother were leaving his office, they ran into her regular OB/GYN, Elizabeth Collins, whom Shalon trusted completely. Collins took a look and diagnosed a hematoma - blood trapped in layers of healing skin, something that happens in about 1 percent of C-sections. She drained the "fluctuant mass" (as her notes described it), and "copious bloody non-purulent material" poured out from the 1-inch incision. Collins also arranged for a visiting nurse to come by the house every other day to change the dressing.

What troubled the nurse most, though, was Shalon's blood pressure. On Jan. 16 it was 158/100, high enough to raise concerns about postpartum pre-eclampsia, which can lead to seizures and stroke. But Shalon didn't have other symptoms, such as headache or blurred vision. She made an appointment to see the OB/GYN for the next day, then ended up being too overwhelmed to go, the visiting nurse noted on Jan. 18. In that same record, the nurse wrote that Shalon had to change the dressing on her wound "sometimes several times a day due to large amounts of red drainage. This is adding to her stress as a new mom." Her pain was 5 on a scale of 10, preventing her from "sleeping/relaxing." Overall, Shalon told the nurse, "it just doesn't feel right." When the nurse measured her blood pressure on the cuff Shalon kept at home, the reading was 158/112. On the nurse's equipment, the reading was 174/118.

Under current ACOG guidelines, those readings were high enough to warrant more aggressive action, Tsigas said, such as an immediate trip to the doctor for further evaluation, possibly medication, and more careful monitoring. That is especially true for someone with a history of hypertension and multiple other risks. "We need to look holistically at the risk factors irrespective of whether or not she had a diagnosis of pre-eclampsia," Tsigas said. "If somebody has a whole plateful of risk factors, how are you treating them differently?"

"It would have made sense to admit her to the hospital for a complete work-up," including chest X-ray, an echocardiogram to evaluate for heart failure, and titration of her medication to get her blood pressure to normal range, wrote one doctor, a leading expert on postpartum care, who agreed to look at Shalon's records at ProPublica's request but asked not to be identified. The doctor said that the communication about signs of stroke seemed insufficient and that it would be more "common practice" to assess her that day to find out what was wrong.

Instead, Shalon was given an appointment for the next day, Jan. 19, with an OB/GYN at Women's Center at Emory St. Joseph's, which handled her primary care. By then, Shalon's blood pressure had fallen to 130/85 - considered on the high end of normal - and there were "no symptoms concerning for postpartum [pre-eclampsia]," the doctor wrote in his notes. He wrote that Shalon was healing "appropriately" and thought her jumps in blood pressure were likely related to "poor pain control." Wanda and Shalon left feeling more frustrated than ever.

At home over the next couple of days, Wanda noticed that one of Shalon's legs was larger than the other. "She said, 'Yeah, I know, Mom, and my knee hurts, I can't bend it.' "

When McDonald-Mosley looked over the voluminous medical records a few months later, what jumped out at her was the sense that Shalon's caregivers (who declined to comment for this story) didn't seem to think of her as a patient who needed a heightened level of attention, despite the complexity of her pregnancy.

"She had all these risk factors. If you're gonna pick someone who's going to have a problem, it's gonna be her. ... She needs to be treated with caution." The fact that her symptoms defied easy categorization was all the more reason to be vigilant, McDonald-Mosley said. "There were all these opportunities to identify that something was going wrong. To act on them sooner and they were missed. At multiple levels. At multiple parts of the health care system. They were missed."

Shalon's other friends were growing uneasy, too. Pryor had her own pregnancy emergency - her son was born very prematurely, at 24 weeks - so she couldn't be in Atlanta. But she and Shalon talked often by phone. "She knew so much about her body one would think she was an M.D. and not a Ph.D. To hear her be concerned about her legs - that worried me." Pryor encouraged her, " 'Friend, are you getting out of the house? Are you going for your walks?' She told me, 'No, I'm on my chaise lounge, and that's about as much as I can do.' "

Life coach Tran was so upset at Shalon's condition that she took her frustrations out on her friend. "I was cussing her out. 'Go to the f****** doctor.' She's like, 'I called them. I talked to them. I went to see them. Get off my back.' "

"There is something wrong"

On the morning of Tuesday, Jan. 24, Shalon took a selfie with her father, who had been visiting for a few days, then sent him to the airport to catch a flight back to Portland. Toward noon, she and Wanda and the baby drove to the Emory Women's Center one more time. This time, Shalon saw a nurse practitioner. "We said, 'Look, there's something wrong here; she's not feeling well,' " Wanda recalled. " 'One leg is larger than the other; she's still gaining weight - 9 pounds in 10 days - the blood pressure is still up. There's gotta be something wrong.' "

The nurse's notes confirmed Shalon had swelling in both legs, with more swelling in the right one. She noted that Shalon had complained of "some mild headaches" but didn't have other worrisome symptoms, like blurred vision. She checked the incision - "warm dry no [sign/symptom] of infection" - and noted Shalon's mental state ("cooperative, appropriate mood & affect, normal judgment").

" 'You guys have to realize she just had a baby. Don't worry about it, things are calming down,' " Wanda recalled the nurse telling them. " 'We'll send her down for an ultrasound to see if she has a clot in her leg.' " Shalon's blood pressure was back up to 163/99, so the nurse also ordered a pre-eclampsia screening.

Both tests came back negative. "So they're saying, 'Well if there's no clots, there's nothing wrong,' " Wanda recalled. As Wanda remembers it, Shalon was insistent: "There is something wrong, I know my body. I don't feel well, my legs are swollen, I'm gaining weight. I'm not voiding. I'm drinking a lot of water, but I'm retaining the water." As Wanda recalls it, the nurse told them, "There is nothing we can do; you just have to wait, give it more time." Before sending Shalon home, the nurse gave her a prescription for the blood pressure medication nifedipine, which is often used to treat pregnancy-related hypertension.

Shalon and Wanda stopped at the pharmacy, then decided to go out to dinner with the baby. While they ate, they talked about a trip Shalon had planned for the three of them to take in just a few weeks. Ever since Sam III had died, Wanda and Shalon had made a point of traveling someplace special on painful anniversaries. To mark his 40th birthday and the eighth anniversary of his death, Shalon had gotten the idea of going to Dubai. ("It's cheap," Shalon had told Wanda. "The money is worth so much more there. It's supposed to be beautiful.") She had long ago purchased their tickets and ordered the baby's passport. Now Wanda was worried - would she be feeling well enough to make such a big trip with an infant? Shalon wasn't willing to give up hope just yet. Wanda recalls her saying, "I'll be fine, I'll be fine."

They got home and sat in Shalon's bedroom for a while, laughing and playing with the baby. Around 8:30 p.m., Shalon suddenly declared, "I just don't know, Mom, I just don't feel well." She took the blood pressure medication from Wanda and got ready for bed. An hour later, Wanda heard a terrifying gasping noise. Shalon had collapsed.

The news spread quickly among her colleagues at the CDC. William Callaghan, chief of the maternal and infant health branch, recalled in March that his boss, who had visited Shalon at the hospital, called to let him know. "It was a chilling phone call," said Callaghan, one of the nation's leading researchers on maternal mortality. "It certainly takes, in that moment, what I do, it made it very, very, very concrete. ... This was not about data, this was not about whether it was going up or it was going down. It was about this tragic event that happened to this woman, her family."

Northside decided against an autopsy, telling Wanda and Samuel that there was nothing unusual about Shalon's death, they recalled. (The hospital declined to comment.) So Wanda paid $4,500 for an autopsy by the medical examiners in neighboring DeKalb County. The report came back three months later. Noting that Shalon's heart showed signs of damage consistent with hypertension, it attributed her death to complications of high blood pressure.

Raising Soleil

Wanda moved into Shalon's tidy town house to care for Soleil. Even though Shalon's villagers fulfilled their pledges at the memorial service, coming by often to give Wanda a break, the first months were borderline unbearable - the baby was colicky, prone to gastric problems that kept both of them up all night. Wanda's grief was endless, bottomless, but she couldn't let it interfere with her duties to Soleil. "She's the only reason I get up every morning, pretty much," Wanda said.

Eventually the colic went away and Soleil thrived. In June, Wanda and her 5-month-old granddaughter drove to Chattanooga, Tenn., for the annual meeting of U.S. Public Health Service scientists. A new honor - the Shalon Irving Memorial (Junior) Scientist Officer of the Year Award- had been created to celebrate Shalon's legacy, and Wanda had been asked to say a few words. She handed the baby to one of Shalon's CDC colleagues and took the small stage.

"Striving for excellence is a choice," she told the audience through barely suppressed tears. "It is a commitment. ... It's a struggle to become the person you want to be. It's harder than you want. It takes longer than you want. And it takes more out of you than you expected it should."

Shalon personified excellence, Wanda said. "I don't know if Shalon became the woman that she ultimately wanted to be. But I do know that she wanted to be the woman she was."

One Saturday afternoon in October, Wanda received a book that friends of Shalon's from the Epidemic Intelligence Service had compiled, titled Letters to Soleil. She put Soleil on her lap and said, "I'm gonna read you some letters about your mom." One thing Wanda has tried never to do is cry in front of Soleil. But as she began reading the letters, she was sobbing. "And Soleil just kept looking at me - she couldn't understand what was going on. And about a minute later she took my glasses off with her hands and put them down and then laid her head right on my chest and started patting me. Which made me cry all the more."

As Soleil got older, Wanda looked forward to doing the kinds of things with her that Shalon had looked forward to: reading to her, traveling with her, taking her to gymnastics and music classes. "She wanted Soleil to go to Montessori school, so I'm looking for a Montessori school for her," Wanda said. "She wanted her to be christened; we got her christened."

Now 10 months old, Soleil has her mother's eyes, energy and headstrong yet sweet disposition, coming into Wanda's bed every night and waking her early to play. "She'll bite my nose and kick me - 'Nana, time to get up! Time to get up!' That's what keeps me motivated."

A week or so after the memorial service, Wanda came across a letter that Shalon had written to her two years earlier, around the sixth anniversary of Sam III's death. Shalon had left it among the other important items on her computer, trusting that if something ever happened to her, Wanda would find it. The letter reads like a premonition: Shalon was contemplating the prospect of her own premature death - and of her beloved mother having to endure one more unbearable tragedy.
I am sorry that I have left you. On the particular day that I am writing this I have no idea how that may have occurred but know that I would never choose to leave. I know it seems impossible right now, but please do not let this break you. I want you to be happy and smile. I want you to know that I am being watched after by my brothers and grandma and that we are all watching you. Please try not to cry. Use your energy instead to feel my love through time and space. Nothing can break the bond we have and you will forever be my mommy and I your baby girl!

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Black Mothers Keep Dying After Giving Birth. Shalon Irving's Story Explains Why

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Black women are three times more likely to die from complications of childbirth than white women in the U.S. Racism, and the stress it causes, can play a leading role in that disparity.

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From Academy Award nominated director Roko Belic, HAPPY takes us on a journey from the swamps of Louisiana to the slums of Kolkata in search of what really makes people happy. Combining real life stories from around the world and powerful interviews with leading scientists in happiness research, HAPPY explores the secrets behind out most valued emotion.

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Around 2012, something started going wrong in the lives of teens.

In just the five years between 2010 and 2015, the number of U.S. teens who felt useless and joyless - classic symptoms of depression - surged 33 percent in large national surveys. Teen suicide attempts increased 23 percent. Even more troubling, the number of 13- to 18-year-olds who committed suicide jumped 31 percent.

In a new paper published in Clinical Psychological Science, my colleagues and I found that the increases in depression, suicide attempts and suicide appeared among teens from every background - more privileged and less privileged, across all races and ethnicities and in every region of the country. All told, our analysis found that the generation of teens I call " iGen " - those born after 1995 - is much more likely to experience mental health issues than their millennial predecessors.

What happened so that so many more teens, in such a short period of time, would feel depressed, attempt suicide and commit suicide? After scouring several large surveys of teens for clues, I found that all of the possibilities traced back to a major change in teens' lives: the sudden ascendance of the smartphone.

All signs point to the screen

Because the years between 2010 to 2015 were a period of steady economic growth and falling unemployment, it's unlikely that economic malaise was a factor. Income inequality was (and still is) an issue, but it didn't suddenly appear in the early 2010s: This gap between the rich and poor had been widening for decades. We found that the time teens spent on homework barely budged between 2010 and 2015, effectively ruling out academic pressure as a cause.

However, according to the Pew Research Center, smartphone ownership crossed the 50 percent threshold in late 2012 - right when teen depression and suicide began to increase. By 2015, 73 percent of teens had access to a smartphone.

Not only did smartphone use and depression increase in tandem, but time spent online was linked to mental health issues across two different data sets. We found that teens who spent five or more hours a day online were 71 percent more likely than those who spent less than an hour a day to have at least one suicide risk factor (depression, thinking about suicide, making a suicide plan or attempting suicide). Overall, suicide risk factors rose significantly after two or more hours a day of time online.

Of course, it's possible that instead of time online causing depression, depression causes more time online. But three other studies show that is unlikely (at least, when viewed through social media use).

Two followed people over time, with both studies finding that spending more time on social media led to unhappiness, while unhappiness did not lead to more social media use. A third randomly assigned participants to give up Facebook for a week versus continuing their usual use. Those who avoided Facebook reported feeling less depressed at the end of the week.

The argument that depression might cause people to spend more time online doesn't also explain why depression increased so suddenly after 2012. Under that scenario, more teens became depressed for an unknown reason and then started buying smartphones, which doesn't seem too logical.

What's lost when we're plugged in

Even if online time doesn't directly harm mental health, it could still adversely affect it in indirect ways, especially if time online crowds out time for other activities.

For example, while conducting research for my book on iGen, I found that teens now spend much less time interacting with their friends in person. Interacting with people face to face is one of the deepest wellsprings of human happiness; without it, our moods start to suffer and depression often follows. Feeling socially isolated is also one of the major risk factors for suicide. We found that teens who spent more time than average online and less time than average with friends in person were the most likely to be depressed. Since 2012, that's what has occurred en masse: Teens have spent less time on activities known to benefit mental health (in-person social interaction) and more time on activities that may harm it (time online).

Teens are also sleeping less, and teens who spend more time on their phones are more likely to not be getting enough sleep. Not sleeping enough is a major risk factor for depression, so if smartphones are causing less sleep, that alone could explain why depression and suicide increased so suddenly.

Depression and suicide have many causes: Genetic predisposition, family environments, bullying and trauma can all play a role. Some teens would experience mental health problems no matter what era they lived in.

But some vulnerable teens who would otherwise not have had mental health issues may have slipped into depression due to too much screen time, not enough face-to-face social interaction, inadequate sleep or a combination of all three.

It might be argued that it's too soon to recommend less screen time, given that the research isn't completely definitive. However, the downside to limiting screen time - say, to two hours a day or less - is minimal. In contrast, the downside to doing nothing - given the possible consequences of depression and suicide - seems, to me, quite high.

It's not too early to think about limiting screen time; let's hope it's not too late.

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With teen mental health deteriorating over five years, there's a likely culprit

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Around 2012, something started going wrong in the lives of teens. In just the five years between 2010 and 2015, the number of U.S. teens who felt useless and joyless - classic symptoms of depression - surged 33 percent in large national surveys. Teen suicide attempts increased 23 percent.

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Joseph L. Dieleman, lead author of the study and an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, gathered information on 155 separate health conditions and six possible treatment categories: inpatient, outpatient (hospital), emergency services, dental care, prescriptions and nursing facilities.

The researchers also analyzed changes in five factors -- population size, aging, disease incidence, use of services, and service price and intensity -- as they relate to health care spending in the study period, 1996 through 2013.

"Intensity of care" refers to service variety and complexity. "It's the difference between a relatively simple X-ray as a compared to more complex MRIs and other forms of diagnostic services," Dieleman wrote in an email.

The analysis resulted in four main takeaways about why US health care costs rose.

Rising price of services

"Price and the variety and complexity of services is the largest driver of health care spending increases," Dieleman noted.

In fact, more than half of the total spending increase was due to price and intensity increases, which contributed $583.5 billion to the $933.5 billion total increase. Dieleman said price and intensity increased for most conditions "and especially for inpatient care."

By comparison, the growth in population led to $269.5 billion of the total expenditures, while aging of the population equaled $135.7 billion of the total.

More spent on specific conditions

Diabetes was the condition with the greatest increase in spending, rising by $64.4 billion between 1996 and 2013. Most of this money went to pharmaceuticals prescribed to treat it.

The single most important risk factor for type 2 diabetes is obesity, noted Dr. Patrick H. Conway of Blue Cross Blue Shield of North Carolina in an editorial published alongside the new analysis.

Spending on low-back and neck pain surged by $57.2 billion in the 17-year time period, followed by hypertension ($47.6 billion), hyperlipidemia or high ("bad") cholesterol ($41.9 billion), depressive disorders ($30.8 billion), falls ($30.4 billion), urinary diseases ($30.2 billion), osteoarthritis ($29.9 billion), sepsis or bloodstream infection ($26.0 billion), and oral diseases or disorders ($25.3 billion).

Outpatient treatment

Spending on ambulatory care, which includes ER and outpatient hospital services, also played a role in increased overall costs. Annual spending on ambulatory care swelled from $381.5 billion in 1996 to $706.4 billion in 2013. This increase, about $324 billion, was higher than any of the other five types of care analyzed.

There's a "significant payment differential" when a procedure, such as a colonoscopy, is performed at an outpatient hospital center compared with when it is performed in a physician's office, "with the former being far more expensive than the latter," Conway noted.

Pharmaceutical drugs

Another key driver of the total increase in health care expenditures between 1996 and 2013 was spending on pharmaceutical drugs. For example, $44.4 billion of the total $64.4 billion increased expenditure for diabetes was spent on medications meant to treat, as well as to prevent, the disease.

Part of the high price paid for pharmaceuticals "is a regulatory problem," said Robert F. Graboyes, a senior research fellow at the Mercatus Center at George Mason University. Graboyes, who was not involved in the research, said that the FDA drug approval process makes pharmaceuticals far more expensive than they ought to be.

"The FDA has a very powerful motive to take things extremely slowly and extremely carefully," he said. Although slow and careful has its virtues when it comes to something as "sensitive" as pharmaceutical drugs, Graboyes noted that the United States lacks something the European Union has.

"There is a counterweight in the motive that says you also don't want to be too slow about it," he said.

In Europe, rather than a single agency, there are a number of "quasi-private entities approved by the governments of the EU," and so there is a somewhat "competitive system." The result: "They do tend to get things to market quickly without -- as far as I can see -- any loss of safety and security," he said.

Graboyes described the overall spending report as "well-done."

Household perspective best

Based on official US records, total health care spending reached $3.2 trillion in 2015 and constituted 17.8% of the US economy, Dieleman and his co-authors noted.

Graboyes said that when it comes to health care spending, it can be misleading to focus "on percentage of GDP rather than a percentage of household consumption."

He suggested we look instead at what Americans spend on health care as a percentage of household consumption expenditures.

"It turns out that we're not very far out of line with other countries," he said.

This is not a criticism; "it's more of an addition to the paper," Graboyes said. "It's an interesting factor to overlay on the work they've done."

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4 reasons why us health care is so expensive  - cnn

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4 reasons why US health care is so expensive

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Joseph L. Dieleman, lead author of the study and an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, gathered information on 155 separate health conditions and six possible treatment categories: inpatient, outpatient (hospital), emergency services, dental care, prescriptions and nursing facilities.

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23:00 Heroin(e)

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Andrew Kolodny is Co-Director of Opioid Policy Research at Brandeis University
Drug overdose deaths, once rare, are now the leading cause of accidental death in the U.S., surpassing peak annual deaths caused by motor vehicle accidents, guns and HIV infection.

As a former public health official, clinician and researcher, I've been engaged in efforts to control the opioid addiction epidemic for the past 15 years.

The data show that the situation is dire and getting worse. Until opioids are prescribed more cautiously and until effective opioid addiction treatment becomes easier to access, overdose deaths will likely remain at record high levels.

How the crisis started

Opioids are drugs that stimulate the brain's opiate receptors. Some are made from opium and some are completely synthetic. In the U.S., the most commonly prescribed opioids are hydrocodone and oxycodone, which are classified as semi-synthetic because they are synthesized from opium. Heroin is also a semi-synthetic opioid. The effects of hydrocodone and oxycodone on the brain are indistinguishable from the effects produced by heroin.

Opioids are essential medicines for palliative care. They are also helpful when used for a couple of days after major surgery or a serious accident. Unfortunately, the bulk of the opioid prescriptions in the U.S. are for common conditions, like back pain.

In these cases, opioids are more likely to harm patients than help them because the risks of long-term use, such as addiction, outweigh potential benefit. Opioids have not been proven effective for daily, long-term use. Evidence suggests that chronic use of opioids can even make pain worse, a phenomenon called hyperalgesia.

Over the last two decades, as prescriptions for opioids began to soar, rates of addiction and overdose deaths increased in parallel.

The increase in opioid prescription was fueled by a multifaceted campaign underwritten by pharmaceutical companies. Doctors heard from their professional societies, their hospitals and even from state medical boards that patients were suffering needlessly because of an overblown fear of addiction.

The campaign minimized opioid risks and exaggerated the benefits of using opioids over the long term for chronic pain. Several states and counties have recently filed lawsuits against opioid manufacturers for the role they played in causing the opioid addiction epidemic by misleading the medical community.

The rise of heroin

Until 2011, most opioid overdose deaths involved prescription opioids. Then prescription opioid overdose deaths leveled off, while overdose deaths involving heroin began to soar.

Why did this happen? A common misconception is that so-called "drug abusers" suddenly switched from prescription opioids to heroin due to a federal government "crackdown" on painkillers.

Substance Abuse and Mental Health Services Administration

There is a kernel of truth in this narrative. It's true that the vast majority of people who started using heroin after 1995 switched from prescription opioids because heroin was easier to obtain. But heroin use among young whites has been increasing since before 2011. From the beginning of the opioid crisis, young adults who became addicted to prescription opioids would switch to heroin, a less expensive option.

As young people switched to heroin, the heroin supply also became more dangerous. This caused the sharp increase in heroin overdose deaths in 2011. Increasingly, fentanyl, a potent and inexpensive synthetic opioid, was mixed with heroin or sold as heroin.

Until 2013, medical examiners didn't routinely test heroin overdose victims for the presence of fentanyl, but once they did, an alarming trend appeared. Preliminary data indicate that, in 2016, deaths involving fentanyl surpassed deaths involving prescription opioids and heroin.

Treating the crisis

There's another reason not to believe the narrative about a "crackdown" on painkillers leading to a sudden shift to heroin: There hasn't been a crackdown on prescription opioids. Despite some slowdown, the medical community continues to overprescribe opioids.

In fact, U.S. per capita opioid consumption is much higher than other developed nations. Our oxycodone consumption has started to decline, but it remains much higher than oxycodone consumption in Europe.

To bring the opioid addiction epidemic under control, the medical community must be more cautious about prescribing opioids. Federal and state governments also have to ensure that the millions of Americans now suffering from opioid addiction can access effective addiction treatment.

Buprenorphine and methadone maintenance -- also known as medication-assisted treatment -- are preferred treatments for opioid addiction. When patients with addiction take these medications, they are able to function and have an improved quality of life. These treatments also reduce the risk of overdose death and injection-related infectious diseases.

Buprenorphine is safer than methadone and other opioids, so it can be prescribed from a doctor's office. Methadone maintenance is administered under supervision in clinics that patients visit daily.

Unfortunately, many patients are unable to access these treatments. Despite a sharp rise in opioid addiction over the past decade, there has been only a slight increase in referrals for medication-assisted treatment in state-licensed drug treatment programs. Patients who are able to obtain treatment with buprenorphine must often visit private practice physicians who don't accept commercial insurance or Medicaid.

Until effective treatment for opioid addiction is easier to access than opioid painkillers, heroin or fentanyl, opioid overdose deaths are likely to remain at record high levels.
This article was originally published on The Conversation.

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Andrew Kolodny is Co-Director of Opioid Policy Research at Brandeis University Drug overdose deaths, once rare, are now the leading cause of accidental death in the U.S., surpassing peak annual deaths caused by motor vehicle accidents, guns and HIV infection.

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c-sections

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"The Business of Being Born" 2007 Trailer

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www.thebusinessofbeingborn.com Birth: it's a miracle. A rite of passage. A natural part of life. But more than anything, birth is a business. Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to examine and question the way American women have babies.

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Sitting disease by the numbers

The term "Sitting Disease" has been coined by the scientific community and is commonly used when referring to metabolic syndrome and the ill-effects of an overly sedentary lifestyle. However, the medical community does not recognize Sitting Disease as a diagnosable disease at this time.

Get the message out! This infographic is free to use on any web site with attribution per Creative Commons Attribution 3.0 Unported License. PDF download is available as a flyer.

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Sitting Disease By The Numbers Infographic | JustStand.org

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The term "Sitting Disease" has been coined by the scientific community and is commonly used when referring to metabolic syndrome and the ill-effects of an overly sedentary lifestyle. However, the medical community does not recognize Sitting Disease as a diagnosable disease at this time. Get the message out!

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Crystal Meth - The World Most Dangerous Drugs - Documentary

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scource: http://youtu.be/3tDdJpyGH94 Crystal Meth - The World Most Dangerous Drugs - Documentary Crystal Meth - The World Most Dangerous Drugs - Documentary Crystal Meth - The World Most Dangerous Drugs - Documentary Methamphetamine (Drug), World, History, New, Documentary, Crystal Meth, Drugs, Dangerous, Most, 2014, Addiction, Obsession, Crime, Police, Drug

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Johann Hari: Everything you think you know about addiction is wrong

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What really causes addiction -- to everything from cocaine to smart-phones? And how can we overcome it? Johann Hari has seen our current methods fail firsthand, as he has watched loved ones struggle to manage their addictions. He started to wonder why we treat addicts the way we do -- and if there might be a better way.

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Alive Inside Official Trailer 1 (2014) - Alzheimer's Documentary HD

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Jon Ronson: Strange answers to the psychopath test

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Is there a definitive line that divides crazy from sane? With a hair-raising delivery, Jon Ronson, author of The Psychopath Test, illuminates the gray areas between the two. (With live-mixed sound by Julian Treasure and animation by Evan Grant.)

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Published May 1, 2016 at 7:18 PM

Anorexia. Bulimia. Binge Eating. Millions across the globe suffer from some form of eating disorder. In the U.S. eating disorders are the biggest killers of all mental illnesses.

Correspondent Mike Kirsch reports on this deceptive disease and its devastating impact.

In the United States at least thirty million people suffer from anorexia or bulimia or other forms of eating disorders. In fact, someone dies in the U.S. each hour of every day. Yet funding for research and treatment for the disease is sparse. This despite the fact that some health experts consider eating disorders to be at epidemic levels.

Take a look at Mike's package for "Americas Now" to learn more about this serious health condition and its often tragic consequences.

Related stories you may also like:

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Examining the eating disorder epidemic in the U.S.

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Published May 1, 2016 at 7:18 PM Anorexia. Bulimia. Binge Eating. Millions across the globe suffer from some form of eating disorder. In the U.S. eating disorders are the biggest killers of all mental illnesses. Correspondent Mike Kirsch reports on this deceptive disease and its devastating impact.

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This story was originally published on Nov. 22, 2009. It was updated on Aug. 6, 2010.

Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked.

Now you might think this would have been an obvious thing for Congress to address when it passed health care reform, but as we reported last November in the midst of the debate, what use to be a bipartisan issue has become a politically explosive one - a perfect example of the rising costs that threaten to bankrupt the country and how hard it is to rein them in.

Marcia Klish is either being saved by medical technology or being prevented from dying a natural death.

She is 71 years old and suffering from the complications of colon surgery and a hospital-acquired infection. She has been unconscious in the intensive care unit at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., for the better part of a week.

One of her doctors, Ira Byock, told "60 Minutes" correspondent Steve Kroft it costs up to $10,000 a day to maintain someone in the intensive care unit. Some patients remain here for weeks or even months; one has been there for six months.

"This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU," Byock told Kroft. "And, you know, it's extremely expensive. It's uncomfortable. Many times they have to be sedated so that they don't reflexively pull out a tube, or sometimes their hands are restrained. This is not the way most people would want to spend their last days of life. And yet this has become almost the medical last rites for people as they die."

Dr. Byock leads a team that treats and counsels patients with advanced illnesses.

He says modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily.

"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it's having someone you love die badly," Byock said.

Asked what he means by "die badly," Byock told Kroft, "Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that's collectively what we're doing."

A vast majority of Americans say they want to die at home, but 75 percent die in a hospital or a nursing home.

"How do so many people end up in the hospital?" Kroft asked Dr. Elliott Fisher, a researcher at the Dartmouth Institute for Health Policy.

"It's the path of least resistance," Fisher said.

The institute did a detailed analysis of Medicare records for patients in the last two years of their lives. Fisher says it is more efficient for doctors to manage patients who are seriously ill in a hospital situation, and there are other incentives that affect the cost and the care patients receive. Among them: the fact that most doctors get paid based on the number of patients that they see, and most hospitals get paid for the patients they admit.

"The way we set up the system right now, primary care physicians don't have time to spend an hour with you, see how you respond, if they wanted to adjust your medication," Fisher said. "So, the easiest thing for everybody up the stream is to admit you to the hospital. I think 30 percent of hospital stays in the United States are probably unnecessary given what our research looks like."

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This story was originally published on Nov. 22, 2009. It was updated on Aug. 6, 2010. Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.

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CANCER: THE EMPEROR OF ALL MALADIES Trailer with special introduction by Dr. Siddhartha Mukherjee

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The Leukemia & Lymphoma Society (LLS) is a proud supporter of Ken Burns Presents CANCER: THE EMPEROR OF ALL MALADIES, a film by Barak Goodman. Based on Siddhartha Mukherjee's 2010 Pulitzer Prize‐winning book, "The Emperor of All Maladies: A Biography of Cancer." LLS-funded research contributed to breakthroughs that helped tame some of the most lethal blood cancers.

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Watch full-length episodes of PBS documentary series FRONTLINE for free. Supplements and Safety - An investigation into the hidden dangers of vitamins and supplements, with The New York Times and the Canadian Broadcasting Corporation.

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Just about everyone probably knows someone whose child is being medicated for attention deficit disorder, attention deficit hyperactivity disorder or a bipolar disorder.

The diagnoses are increasingly common at younger ages, but doctors and parents are sometimes at odds about how young is too young, RTV6's Tanya Spencer reported.

A Columbia University study showed that 1 in 70 preschoolers are taking a psychiatric drug, though the long-term effects on children of some of the brain-altering medications haven't been studied.

Some of the drugs are not approved by the Food and Drug Administration for children under age 6, but that doesn't stop physicians from prescribing them to toddlers, in some cases.

Jennifer Goodin is all too familiar with the dilemma. Doctors wanted to start her son, Carter, on psychiatric medication when he was 3, but she wanted to wait.

"It's hard, because you're giving a child a medicine that you don't really know what it's doing to them," Goodin said.

Carter, who was diagnosed with ADHD, is now 7. In his short life, he has already been on Strattera, Adderall, Zoloft, Daytrana, Kapvay and Intuniv, in addition to medicine he takes for the treatment of seizures.

Goodin said her son exhibited more negative behavior while on some of the medications and that other drugs sedated him so much that she could hardly get him out of bed in the morning.

Another prescription caused muscle twitches so severe that they made Carter cry, Goodin said.

The Goodins are still searching for the right mix of medications for their son, but they worry about the long-term effects.

"It's just a constant struggle and a constant battle, especially with him," Goodin said. "He's non-verbal, so he can't really communicate with us his reaction to the drugs. We just have to read that, but it's hard because you're giving a child a medicine that you don't really know what it's doing to them."

In many cases, even the experts don't know how a child will react to powerful medication.

Dr. Leslie Hulvershorn, a child and adolescent psychiatrist at Riley Hospital for Children, said there is no doubt the commonly prescribed psychiatric drugs are changing how young brains are developing.

Hulvershorn believes that while the medications can be extremely helpful for some kids, they can be very dangerous for others.

In her practice, she's seen young children over-diagnosed and drugs to treat them over-prescribed.

"Physicians and other mental health professionals are under pressure to code a diagnosis in order to be able to bill," Hulvershorn said. "Families will go from provider to provider and hear different diagnoses because it's just unclear what's going on at that age."

As a general rule, Hulvershorn only prescribes to children age 5 and older.

"You really have a hard time under the age of 4 and 5 differentiating between what's a typical toddler tantrum and what's a pathological behavior," she said.

Hulvershorn and other experts in the field of child and adolescent psychiatry are especially concerned about the off-label use of strong psychiatric drugs. That's when a drug is prescribed to treat a condition for which it has not been FDA-approved.

"For example, you might have a drug that's developed for schizophrenia that is then used to treat aggression in kids," she said. "We see a lot of kids coming in on those who've never even been on the appropriate medication for ADHD and were put on those first. So, I think that's a concern."

Hulvershorn said she had recently seen a case in which a child had been placed on several strong psychotropic medications that might be used to treat adult bipolar disorder or schizophrenia.

"He'd been on them for a long time and had really serious side effects," she said.

The side effects are a concern for Jennifer Gearlds, whose stepson, Kurt, began struggling with behavior problems at age 7.

"That's why we had never tried anything before. I was just cautious about trying different medications," Gearlds said.

The family turned to medication when Kurt was 8, but Gearlds said the meds made Kurt very, very angry and that he was hiding pills to avoid taking them.

The Gearlds laid off medication for six years. But recently, Kurt started taking a new prescription, with what the family called amazing results.

"A huge difference -- his behavior is better. He's participating at home as a family all the time, not avoiding everything," she said. "He's brought all of his grades up from Ds and Fs to As and Bs."

"It was about maybe three or four weeks after I started taking it I could tell I was focusing a lot more," Kurt said.

With his grades up so dramatically, Kurt hopes to go to college and maybe eventually into sports broadcasting.

"I wish we would have done something sooner, so he would have liked school better and we wouldn't have had all the stress for the last at least five years," Gearlds said.

Hulvershorn said the biggest challenge parents often face is finding qualified child psychiatrists with experience in prescribing brain-altering medications.

"There's a shortage. In all of medicine, the biggest shortage of physicians is of child and adolescent psychiatry," she said. "It's very hard to find people who feel comfortable and have had adequate training to prescribe, and pediatricians are kind of left in the lurch with these kids who need help."

Hulvershorn advises parents to always get a second opinion and to seek out a physician with expertise in the particular diagnosis a child is dealing with.

Parents should always try therapy first and medicate as a last resort. If a child does go on medication, it should start with a low dose.

Until adequate testing is done, the possible long-term effects of some powerful drugs are unknown.

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Small Children, Big Drugs: Are Kids Overmedicated?

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Just about everyone probably knows someone whose child is being medicated for attention deficit disorder, attention deficit hyperactivity disorder or a bipolar disorder. The diagnoses are increasingly common at younger ages, but doctors and parents are sometimes at odds about how young is too young, RTV6's Tanya Spencer reported.

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http://www.pbs.org/specials/depth-vaccines/ Examining the emotionally charged debate over medical risks versus benefits and a parent's right to make choices about her child versus a communities common good. (Originally broadcast in April, 2010) Vaccines have changed the world, largely eradicating a series of terrible diseases, from smallpox to polio to diphtheria, and likely adding decades to most of our life spans.

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Video Clip: Big  Bucks, Big Pharma Documentary

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Visit http://secure.mef.tv/itemdesc.asp?ic=224-I-D for more information. Newly released by the Media Education Foundation, "Big Bucks, Big Pharma" pulls back the curtain on the multi-billion dollar pharmaceutical industry to expose the insidious ways that illness is used, manipulated, and in some instances created, for capital gain.

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Food, Inc. - Documentary Film Trailer | POV on PBS

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Food Inc. A Documentary Film by Robert Kenner. The film airs on POV on April 21st. How much do we know about the food we buy at our local supermarkets and serve to our families? Though our food appears the same as ever - a tomato still looks like a tomato - it has been radically transformed.

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Opioids: Last Week Tonight with John Oliver (HBO)

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Mental Health Awareness - Male Suicide Increase

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On July 22nd 2015, I was on the Victoria Derbyshire show on the BBC with three other people, talking about our experiences of dealing with suicide and suicidal thoughts. The show was aired after recent figures have shown there has been an increase in the number of men taking their own life, even when they are in the care of Mental Health services.

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NOW PLAYING. FOR THEATERS AND INFO VISIT: fedupmovie.com facebook.com/fedupmovie Twitter: @fedupmovie This is the movie the food industry doesn't want you to see. FED UP blows the lid off everything we thought we knew about food and weight loss, revealing a 30-year campaign by the food industry, aided by the U.S.

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In the 1970s, a mysterious and deadly illness began infecting children in a small town in Connecticut. Today it's a global epidemic. A real-life thriller, this shocking festival hit exposes the controversy surrounding Lyme disease.

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'Dementia Village' gives life to people who need care

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Caring for loved ones with dementia often means stripping them of their independence, but the Dutch are leading the way in care, with an innovative approach, proving it really does take a village. For TODAY, NBC's Keir Simmons reports.

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Watch full-length episodes of PBS documentary series FRONTLINE for free. Hunting the Nightmare Bacteria - FRONTLINE investigates the rise of deadly drug-resistant bacteria.