Why No Gadget Can Prove How Stoned You Are

If you’ve spent time with marijuana—any time at all, really—you know that the high can be rather unpredictable. It depends on the strain, its level of THC and hundreds of other compounds, and the interaction between all these elements. Oh, and how much you ate that day. And how you took the cannabis. And the position of the North Star at the moment of ingestion.

OK, maybe not that last one. But as medical and recreational marijuana use spreads across the United States, how on Earth can law enforcement tell if someone they’ve pulled over is too high to be driving, given all these factors? Marijuana is such a confounding drug that scientists and law enforcement are struggling to create an objective standard for marijuana intoxication. (Also, I’ll say this early and only once: For the love of Pete, do not under any circumstances drive stoned.)

Sure, the cops can take you back to the station and draw a blood sample and determine exactly how much THC is in your system. “It's not a problem of accurately measuring it,” says Marilyn Huestis, coauthor of a new review paper in Trends in Molecular Medicine about cannabis intoxication. “We can accurately measure cannabinoids in blood and urine and sweat and oral fluid. It's interpretation that is the more difficult problem.”

You see, different people handle marijuana differently. It depends on your genetics, for one. And how often you consume cannabis, because if you take it enough, you can develop a tolerance to it. A dose of cannabis that may knock amateurs on their butts could have zero effect on seasoned users—patients who use marijuana consistently to treat pain, for instance.

The issue is that THC—what’s thought to be the primary psychoactive compound in marijuana—interacts with the human body in a fundamentally different way than alcohol. “Alcohol is a water-loving, hydrophilic compound,” says Huestis, who sits on the advisory board for Cannabix, a company developing a THC breathalyzer.1 “Whereas THC is a very fat-loving compound. It's a hydrophobic compound. It goes and stays in the tissues.” The molecule can linger for up to a month, while alcohol clears out right quick.

But while THC may hang around in tissues, it starts diminishing in the blood quickly—really quickly. “It's 74 percent in the first 30 minutes, and 90 percent by 1.4 hours,” says Huestis. “And the reason that's important is because in the US, the average time to get blood drawn [after arrest] is between 1.4 and 4 hours.” By the time you get to the station to get your blood taken, there may not be much THC left to find. (THC tends to linger longer in the brain because it’s fatty in there. That’s why the effects of marijuana can last longer than THC is detectable in breath or blood.)

So law enforcement can measure THC, sure enough, but not always immediately. And they’re fully aware that marijuana intoxication is an entirely different beast than drunk driving. “How a drug affects someone might depend on the person, how they used the drug, the type of drug (e.g., for cannabis, you can have varying levels of THC between different products), and how often they use the drug,” California Highway Patrol spokesperson Mike Martis writes in an email to WIRED.

Accordingly, in California, where recreational marijuana just became legal, the CHP relies on other observable measurements of intoxication. If an officer does field sobriety tests like the classic walk-and-turn maneuver, and suspects someone may be under the influence of drugs, they can request a specialist called a drug recognition evaluator. The DRE administers additional field sobriety tests—analyzing the suspect’s eyes and blood pressure to try to figure out what drug may be in play.

The CHP says it’s also evaluating the use of oral fluid screening gadgets to assist in these drug investigations. (Which devices exactly, the CHP declines to say.) “However, we want to ensure any technology we use is reliable and accurate before using it out in the field and as evidence in a criminal proceeding,” says Martis.

Another option would be to test a suspect’s breath with a breathalyzer for THC, which startups like Hound Labs are chasing. While THC sticks around in tissues, it’s no longer present in your breath after about two or three hours. So if a breathalyzer picks up THC, that would suggest the stuff isn’t lingering from a joint smoked last night, but one smoked before the driver got in a car.

This could be an objective measurement of the presence of THC, but not much more. “We are not measuring impairment, and I want to be really clear about that,” says Mike Lynn, CEO of Hound Labs. “Our breathalyzer is going to provide objective data that potentially confirms what the officer already thinks.” That is, if the driver was doing 25 in a 40 zone and they blow positive for THC, evidence points to them being stoned.

But you might argue that even using THC to confirm inebriation goes too far. The root of the problem isn’t really about measuring THC, it’s about understanding the galaxy of active compounds in cannabis and their effects on the human body. “If you want to gauge intoxication, pull the driver out and have him drive a simulator on an iPad,” says Kevin McKernan, chief scientific officer at Medicinal Genomics, which does genetic testing of cannabis. “That'll tell ya. The chemistry is too fraught with problems in terms of people's individual genetics and their tolerance levels.”

Scientists are just beginning to understand the dozens of other compounds in cannabis. CBD, for instance, may dampen the psychoactive effects of THC. So what happens if you get dragged into court after testing positive for THC, but the marijuana you consumed was also a high-CBD strain?

“It significantly compounds your argument in court with that one,” says Jeff Raber, CEO of the Werc Shop, a cannabis lab. “I saw this much THC, you're intoxicated. Really, well I also had twice as much CBD, doesn't that cancel it out? I don't know, when did you take that CBD? Did you take it afterwards, did you take it before?

“If you go through all this effort and spend all the time and money and drag people through court and spend taxpayer dollars, we shouldn't be in there with tons of question marks,” Raber says.

But maybe one day marijuana roadside testing won’t really matter. “I really think we're probably going to see automated cars before we're going to see this problem solved in a scientific sense,” says Raber. Don’t hold your breath, then, for a magical device that tells you you’re stoned.

1 UPDATE: 1/29/18, 2:15 pm ET: This story has been updated to disclose Huestis' affiliation with Cannabix.

Read more: https://www.wired.com/story/why-no-gadget-can-prove-how-stoned-you-are/

Apple wants to gather all your medical records in the Health app

Apple announced a new health effort as part of iOS 11.3. The new Health Records section in the Health app lets you gather and view all your medical records. The company is partnering with hospitals and clinics.

Apple released the first beta version of iOS 11.3 today. While the new version of iOS is going to remain in beta testing for a couple of months, it should be available as a free download to all iPhone users pretty soon.

Health Records is going to be a new menu in the Health Data section of the Health app. You’ll be able to add any file to this menu as long as it’s a CDA file (Clinical Document Architecture). Some hospitals already email you those files or make them available on their website. But Apple wants to automate this process.

Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine and others are already testing the feature with their patients. Health Records is based on FHIR (Fast Healthcare Interoperability Resources), a standard when it comes to data formats and APIs.

So it means that those hospitals and clinics will be able to push this data to your phone directly. You’ll receive a notification alerting you that you just received a new medical record. Data is encrypted on your phone and protected by your passcode.

And it looks very thorough based on the screenshot. You’ll be able to list your allergies, medications, immunizations and lab results in the Health app.

This could be particularly useful for patients who get a lot of lab results to track cholesterol or something else. Newest results appear at the top of the Healthcare Records timeline.

It’s going to be hard to convince every single hospital and clinic around the U.S. and around the world to adopt the new Health Records feature. But here’s a list of all the institutions participating in the beta test:

  • Johns Hopkins Medicine – Baltimore, Maryland
  • Cedars-Sinai – Los Angeles, California
  • Penn Medicine – Philadelphia, Pennsylvania
  • Geisinger Health System – Danville, Pennsylvania
  • UC San Diego Health – San Diego, California
  • UNC Health Care – Chapel Hill, North Carolina
  • Rush University Medical Center – Chicago, Illinois
  • Dignity Health – Arizona, California and Nevada
  • Ochsner Health System – Jefferson Parish, Louisiana
  • MedStar Health – Washington, D.C., Maryland and Virginia
  • OhioHealth – Columbus, Ohio
  • Cerner Healthe Clinic – Kansas City, Missouri
  1. iPhone_X_Apple_All_Health_Records_Screen_01232018

  2. iPhone_X_Apple_Health_Records_screen_01232018

Read more: https://techcrunch.com/2018/01/24/apple-wants-to-gather-all-your-medical-records-in-the-health-app/

CNN Exclusive: California launches investigation following stunning admission by Aetna medical director

(CNN)California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.

“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.
Aetna, the nation’s third-largest insurance provider with 23.1 million customers, told CNN it looked forward to “explaining our clinical review process” to the commissioner.
    The California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.
    During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.
    Jones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”
    “It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.
    “That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”
    The insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.
    Members of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.
    “Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.
    “This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.

    The Gillen Washington case

    The deposition by Aetna’s former medical director came as part of a lawsuit filed against Aetna by a college student who suffers from a rare immune disorder. The case is expected to go to trial later this week in California Superior Court.
    Gillen Washington, 23, is suing Aetna for breach of contract and bad faith, saying he was denied coverage for an infusion of intravenous immunoglobulin (IVIG) when he was 19. His suit alleges Aetna’s “reckless withholding of benefits almost killed him.”
    Aetna has rejected the allegations, saying Washington failed to comply with their requests for blood work. Washington, who was diagnosed with common variable immunodeficiency, or CVID, in high school, became a new Aetna patient in January 2014 after being insured by Kaiser.
    Aetna initially paid for his treatments after each infusion, which can cost up to $20,000. But when Washington’s clinic asked Aetna to pre-authorize a November 2014 infusion, Aetna says it was obligated to review his medical record. That’s when it saw his last blood work had been done three years earlier for Kaiser.
    Despite being told by his own doctor’s office that he needed to come in for new blood work, Washington failed to do so for several months until he got so sick he ended up in the hospital with a collapsed lung.
    Once his blood was tested, Aetna resumed covering his infusions and pre-certified him for a year. Despite that, according to Aetna, Washington continued to miss infusions.
    Washington’s suit counters that Aetna ignored his treating physician, who appealed on his behalf months before his hospitalization that the treatment was medically necessary “to prevent acute and long-term problems.”
    “Aetna is blaming me for what happened,” Washington told CNN. “I’ll just be honest, it’s infuriating to me. I want Aetna to be made to change.”
    During his videotaped deposition in October 2016, Iinuma — who signed the pre-authorization denial — said he never read Washington’s medical records and knew next to nothing about his disorder.
    Questioned about Washington’s condition, Iinuma said he wasn’t sure what the drug of choice would be for people who suffer from his condition.
    Iinuma further says he’s not sure what the symptoms are for the disorder or what might happen if treatment is suddenly stopped for a patient.
    “Do I know what happens?” the doctor said. “Again, I’m not sure. … I don’t treat it.”
    Iinuma said he never looked at a patient’s medical records while at Aetna. He says that was Aetna protocol and that he based his decision off “pertinent information” provided to him by a nurse.
    “Did you ever look at medical records?” Scott Glovsky, Washington’s attorney, asked Iinuma in the deposition.
    “No, I did not,” the doctor says, shaking his head.
    “So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?” Glovsky asks.
    “Correct.”
    Iinuma said nearly all of his work was conducted online. Once in a while, he said, he might place a phone call to the nurse for more details.
    How many times might he call a nurse over the course of a month?
    “Zero to one,” he said.
    Glovsky told CNN he had “never heard such explosive testimony in two decades of deposing insurance company review doctors.”

    Aetna’s response

    Aetna defended Iinuma, who is no longer with the company, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment and that he was following Aetna’s Clinical Policy Bulletin appropriately.
    “Dr. Iinuma’s decision was correct,” Aetna said in court papers. “Plaintiff has asserted throughout this litigation that Dr. Iinuma had no medical basis for his decision that 2011 lab tests were outdated and that Dr. Iinuma’s decision was incorrect. Plaintiff is wrong on both counts.”
    In its trial brief, Aetna said: “Given that Aetna does not directly provide medical care to its members, Aetna needs to obtain medical records from members and their doctors to evaluate whether services are ‘medically necessary.’ Aetna employs nurses to gather the medical records and coordinate with the offices of treating physicians, and Aetna employs doctors to make the actual coverage-related determinations.
    “In addition to applying their clinical judgment, the Aetna doctors and nurses use Aetna’s Clinical Policy Bulletins (‘CPBs’) to determine what medical records to request, and whether those records satisfy medical necessity criteria to support coverage. These CPBs reflect the current standard of care in the medical community. They are frequently updated, and are publicly available for any treating physician to review.”
    Jones, the California insurance commissioner, said he couldn’t comment specifically on Washington’s case, but what drew his interest was the medical director’s admission of not looking at patients’ medical records.
    “What I’m responding to is the portion of his deposition transcript in which he said as the medical director, he wasn’t actually reviewing medical records,” Jones told CNN.
    He said his investigation will review every individual denial of coverage or pre-authorization during the medical director’s tenure to determine “whether it was appropriate or not for that decision to be made by someone other than a physician.”
    If the probe determines that violations occurred, he said, California insurance code sets monetary penalties for each individual violation.
    CNN has made numerous phone calls to Iinuma’s office for comment but has not heard back. Heather Richardson, an attorney representing Aetna, declined to answer any questions.
    Asked about the California investigation, Aetna gave this written statement to CNN:
    “We have yet to hear from Commissioner Jones but look forward to explaining our clinical review process.
    “Aetna medical directors are trained to review all available medical information — including medical records — to make an informed decision. As part of our review process, medical directors are provided all submitted medical records, and also receive a case synopsis and review performed by a nurse.
    “Medical directors — and all of our clinicians — take their duties and responsibilities as medical professionals incredibly seriously. Similar to most other clinical environments, our medical directors work collaboratively with our nurses who are involved in these cases and factor in their input as part of the decision-making process.”

    ‘A huge admission’

    Dr. Arthur Caplan, founding director of the division of medical ethics at New York University Langone Medical Center, described Iinuma’s testimony as “a huge admission of fundamental immorality.”
    “People desperate for care expect at least a fair review by the payer. This reeks of indifference to patients,” Caplan said, adding the testimony shows there “needs to be more transparency and accountability” from private, for-profit insurers in making these decisions.
    Murphy, the former American Academy of Allergy Asthma and Immunology board member, said he was “shocked” and “flabbergasted” by the medical director’s admission.
    “This is something that all of us have long suspected, but to actually have an Aetna medical director admit he hasn’t even looked at medical records, that’s not good,” said Murphy, who runs an allergy and immunology practice west of Philadelphia.
    “If he has not looked at medical records or engaged the prescribing physician in a conversation — and decisions were made without that input — then yeah, you’d have to question every single case he reviewed.”
    Murphy said when he and other doctors seek a much-needed treatment for a patient, they expect the medical director of an insurance company to have considered every possible factor when deciding on the best option for care.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    “We run into the prior authorization issues when we are renewing therapy, when the patient’s insurance changes or when an insurance company changes requirements,” he said.
    “Dealing with these denials is very time consuming. A great deal of nursing time is spent filling and refilling out paperwork trying to get the patient treatment.
    “If that does not work, then physicians need to get involved and demand medical director involvement, which may or may not occur in a timely fashion — or sometimes not at all,” he said. “It’s very frustrating.”

    Read more: http://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

    For the first time in its history, the Gerber spokesbaby is a child with Down syndrome

    (CNN)This cutie with a contagious smile is 18-month-old Lucas Warren and on Wednesday he made history: He’s the first child with Down syndrome to become Gerber’s “Spokesbaby of the year” in its 91-year history.

    Lucas is from Dalton, Georgia. Gerber picked him from more than 140,000 entries to its photo search contest. The initiative to find the “Gerber Baby” began soon after the company was founded in 1927, when it put out a call looking for a baby to feature in its ads.
    The title means Lucas’ parents will get a $50,000 prize and Lucas will appear on Gerber’s social media channels and will be featured in Gerber ads through the year.
      “We hope this opportunity sheds light on the special needs community and educates people that with acceptance and support, individuals with special needs have the potential to change the world — just like our Lucas,” his mom said.

      Read more: http://www.cnn.com/2018/02/07/health/first-gerber-baby-down-syndrome-trnd/index.html

      Lunar trifecta: Rare ‘super blue blood moon’ will light the sky this week

      (CNN)Set your alarms, space fans — if you can drag yourself out of bed on Wednesday, you’re in for a treat.

      To prepare you for the lunar triple whammy, here’s your all-you-need-to-know guide.

      What is a ‘super blue blood moon’?

        It may sound like the apocalypse is nigh, so let’s break it down by its three parts: “super,” “blue” and “blood.”
        So, a “supermoon” is when a full moon occurs at the same time as its perigee, the closest point of the moon’s orbit with Earth. The result: the moon appears larger than normal and NASA is predicting this one will be 14% brighter than usual.
        Chances are you have used the phrase “once in a blue moon” — but have you ever wondered where it came from? The well-known idiom actually refers to the rare instance when there is a second full moon in a calendar month. The first supermoon of 2018 — which took place on New Year’s Day — was previously described by NASA as the “biggest and brightest” one expected for the entire year.
        Then completing this “lunar trifecta” is the “blood” element. Although it does not have a scientific definition, a “blood moon” occurs during a lunar eclipse when faint red sunbeams peek out around the edges of the Earth, giving it a reddish, copper color.

        Where can I see it?

        Eager stargazers living in North America, Alaska or Hawaii will be able to see the eclipse before sunrise on Wednesday, according to NASA. For those in the Middle East, Asia, eastern Russia, Australia and New Zealand, the “super blue blood moon” will be visible during moonrise on the evening of January 31.
        As long as the weather doesn’t try to ruin things, observers in Alaska, Australia, eastern Asia and Hawaii will be experience the whole phenomenon from start to finish.
        For those living in the US, NASA says the best spots to watch the entire celestial show will be in California and western Canada.
        “Weather permitting, the West Coast, Alaska and Hawaii will have a spectacular view of totality from start to finish,” said George Johnston, lunar blogger at NASA, in a press statement. “Unfortunately, eclipse viewing will be more challenging in the eastern time zone. The eclipse begins at 5.51 a.m. ET, as the moon is about to set in the western sky, and the sky is getting lighter in the east.”
        For observers living in New York or Washington D.C., the space agency suggests a 6.45 a.m. ET start for the best viewing.
        “Your best opportunity if you live in the east is to head outside about 6.45 a.m. and get to a high place to watch the start of the eclipse,” Johnston said. “Make sure you have a clear line of sight to the horizon in the west, opposite from where the sun will rise.”
        Where the moon is covered by the Earth’s shadow, known as the period of totality, it will last just over one and a quarter hours, according to EarthSky. And unlike a solar eclipse, a lunar eclipse is perfectly safe to watch in the night with the naked eye.
        Unfortunately, the eclipse will not be visible from the European or African continents as they will already be in daylight during these hours.
        But fear not, Virtual Telescope will be streaming the event live for anyone unable to view the eclipse up close.
        There are usually a couple of lunar eclipses each year so if you do miss it this time around, the next one will happen on July 27 — though it won’t be visible in North America. It’ll be a long wait for skywatchers in the US as Johnston predicts the next visible lunar eclipse will be on January 21, 2019.
        Be sure to take your favorite pictures and tag #CNNSpace for a chance to be featured.

        Read more: http://www.cnn.com/2018/01/26/world/super-blue-blood-moon-guide-2018-intl/index.html

        Cuckolding can be positive for some couples, study says

        (CNN)In our current political climate, the term “cuck” — short for “cuckservative” — has become an insult of the so-called alt-right, aimed at men they view as spineless and emasculated. The slur has its roots in the concept of cuckolding, or having an adulterous partner.

        But, according to a recent study by David Ley, Justin Lehmiller and the writer Dan Savage, acting on cuckolding fantasies can be a largely positive experience for many couples, and hardly a sign of weakness.
        References to cuckolding appear in literature as early as the 13th century, usually in the form of male characters who fear that their child has been sired by another man during an act of infidelity. Today, however, cuckolding has become fetishized into a powerful sexual fantasy for some men, who get aroused by the idea of their romantic partner engaging in sexual activity with someone else. Women also share this fantasy, but less so than men.
          “This fantasy has been around as long as marriage and sexuality,” said Ley, whose book “Insatiable Wives” addresses cuckolding in heterosexual couples. “But we’re hearing more and more about it these days, and more people are rejecting the social stigma against this fantasy.”
          Indeed, the numbers suggest that cuckolding, or at least thinking about it, is more common than you might imagine. For his forthcoming book, “Tell Me What You Want: The Science of Sexual Desire and How It Can Help Improve Your Sex Life,” Lehmiller surveyed thousands of Americans and found that 58% of men and about a third of women had fantasized about cuckolding.
          “Men are more likely to fantasize about cuckolding, and they do it more often — but there are a number of women who have these fantasies as well, which points to the need for more research focused on women’s cuckolding desires,” Lehmiller said.
          Initially viewed as a heterosexual phenomenon, it’s increasingly prevalent among gay men, too. “I’d long gotten letters from straight couples into cuckolding (usually initiated by the husband), but none from gay couples until after marriage equality began to gather steam,” explained writer and activist Savage. To learn more, Savage joined with Lehmiller and Ley for a study of cuckolding fantasies and experiences in 580 gay men.
          Their findings suggest that there are similarities between the way gay and straight men view cuckolding, but clear differences, too. Most notably, interracial and BDSM themes don’t appear to be as common in gay men’s cuckolding fantasies as they are among heterosexual men. The motivations behind these fantasies may also be different.
          Part of what makes cuckolding arousing for heterosexual men is that they tend to view it as a taboo act. “In a society or culture that idealizes monogamy, the cuckold fantasy is a current narrative that is available to people to conceptualize their sexual fantasies,” said Ley.
          But that may not be an influence for everyone. “For gay men, cuckolding isn’t quite as taboo because the norm of lifelong monogamy isn’t so strong in the LGBT community; however, it can still be arousing for a number of other reasons,” said Lehmiller. For instance, fantasies about voyeurism and group sex seem to overlap with those about cuckolding in these men. “It’s a sexual desire that can be easily customized to meet a wide range of sexual needs and desires, whether it’s taboo sex, novelty, voyeurism or something else,” he told me.
          And the emotions surrounding seeing your partner with someone else can add to the turn-on, explained Savage. “It’s not cuckolding if there isn’t an element of humiliation, degradation or denial,” he said. “Our erotic imaginations have the ability to turn shame lemons into delicious kink lemonade.”
          As a sex therapist, one of the more intriguing findings from this study involves the impact of cuckolding on relationships.
          “Overall, our research found that for the most part, cuckolding tends to be a positive fantasy and behavior,” said Ley. “It doesn’t appear to be evidence of disturbance, of an unhealthy relationship, or of disregard for one’s partner.” But there’s an important caveat, added Lehmiller. “We found several personality factors that predict more positive experiences acting on cuckolding fantasies. For those who have a lot of relationship anxiety or abandonment issues, who lack intimacy and communication, and who aren’t careful, detail-oriented planners, acting on a consensual non-monogamy fantasy could very well be a negative experience,” he said. “In other words, not everyone who has a cuckolding fantasy should think about acting on it.”

          See the latest news and share your comments with CNN Health on Facebook and Twitter.

          Remember that sometimes just sharing a sexy thought can be arousing enough — you don’t have to follow through. If you are thinking about acting on a cuckolding fantasy, it’s worth stepping back first and making sure your relationship is in a good place and that you have strong sexual communication skills.
          “For men and couples considering the issue of cuckolding, it’s important there be honesty, integrity, communication, mutuality and shared values,” advised Ley. “I’ve seen men who try to trick their wives into cuckolding them, and this never, ever ends up well.”
          For couples who do decide to move forward, it’s important to take things slow. “The reality of watching your spouse have sex with someone else — or knowing they’re doing it, if you’re not there — is often very different than the fantasy. It can dredge up powerful emotions, so take baby steps and keep talking and communicating,” said Savage. “That said, the rewards can be amazing, according to couples who have successfully folded cuckold play into their relationships.”

          Read more: http://www.cnn.com/2018/01/25/health/cuckolding-sex-kerner/index.html

          Flu stomps the nation, overwhelming ERs and leaving 20 children dead

          (CNN)The flu virus has reached nearly every corner of the nation.

          Influenza activity is widespread in all states except Hawaii (and the District of Columbia), according to the weekly flu report released Friday by the US Centers for Disease Control and Prevention.
          “Flu is everywhere in the US right now,” said Dr. Dan Jernigan, director of the CDC’s influenza branch. “This is the first year we’ve had the entire continental US at the same level (of flu activity) at the same time.” It has been an early flu season that seems to be peaking now, he said, with a 5.8% increase in laboratory-confirmed cases this week over last.
            There were 11,718 new laboratory-confirmed cases during the week ending January 6, bringing the season total to 60,161. These numbers do not include all people who have had the flu, as many do not see a doctor when sick.
            Seven additional pediatric deaths were reported during the week ending January 6, bringing the total for the season to 20.
            For older people, the CDC estimates deaths based on pneumonia and influenza. Based on National Center for Health Statistics data, 7% of all deaths that occurred during the week ending December 23 were due to pneumonia and influenza. This is above the rate considered normal for this period, according to Lynnette Brammer, head of the CDC’s Domestic Flu Surveillance team.
            Additionally, 22.7 hospitalizations for every 100,000 people occurred over the week ending January 6, compared with 13.7 per 100,000 for the week ending December 30. Those older than 65 represent the largest group hospitalized, though people within the 50-to-64 age range and children younger than 5 are also experiencing high rates of hospitalization.
            “We are currently in the midst of a very active flu season, with much of the country experiencing widespread and intense flu activity,” CDC Director Dr. Brenda Fitzgerald said. “The flu season may be peaking now. We know from past experience it will take many more weeks for flu activity to slow down.”
            Brammer said, “Basically, it looks like things are starting to level off. We didn’t see the sharp increases that we saw the last couple of weeks.”
            “Over the next few weeks, we’ll know if we peaked or not,” she said. “I would hope that the areas that have been hit a little bit earlier in the South and up the West Coast, I’m hoping that those people — particularly some of the states in the South — may have hit their peak and are on their way down.”
            Some of the northern states may still be going up in the number of flu cases, she said. “I wouldn’t be surprised to see that. But, either way, one of the really important things to remember is there are, probably for everybody, weeks to go in this flu season.”
            Vaccine effectiveness has not been calculated, but officials know that the most common strain making people sick this year is H3N2, Brammer said.
            Jernigan said H3N2 seasons are associated with higher rates of hospitalizations and deaths, as well as with lower vaccine effectiveness. He believes that when calculations are made at season’s end, vaccine effectiveness may be around 30% for this season.
            Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, provided a nutshell description of this season: “Started early; it then blossomed essentially all over the country more or less simultaneously. The upswing has been dramatic, and essentially the entire country is affected — some parts more than others — but flu is everywhere.”
            Schaffner suspects that holiday travel helped transport the flu virus and expedited its transmission. “All those hugs and kisses … we’re seeing the consequences now.”
            H3N2, this year’s predominant strain, “tends to produce more severe disease, particularly among older persons,” Schaffner said. “Doctors’ offices, clinics and emergency rooms all over the country are feeling the H3N2 impact right now.”
            Generally, people most at risk for complications are older people, children and people with weak immune systems.
            “Influenza and its complications disproportionately affect people who are 65 and older,” Schaffner said. “They account for 80% of the deaths, and then there are also deaths in younger people, often who have underlying illnesses, such as heart disease, lung disease, diabetes, and also in some young children.”

            Two tragic deaths

            However, flu can also claim the lives of healthy adults such as Jenny Ching, 51, who died January 5 after battling what she thought was just a bad cold.
            Her husband, Matt Ching, told CNN affiliate WCVB that the Massachusetts resident “had the flu, and she also developed a bacterial infection, and it was just really severe and caused severe pneumonia, and her body just didn’t react to antibiotics.”
            Ching said he wasn’t sure whether his wife had gotten a flu shot this season, though in seasons past, that was the norm for the mother of two boys, ages 9 and 7.
            Schaffner noted that “the usual flu death is a person who gets influenza, gets all that inflammation in their chest and then has the complication of pneumonia.” The flu “can take a perfectly healthy person — a child, a young adult, robust — and put them in the ER in 24 to 48 hours.”
            That was the case for Kyler Baughman, 21, who died unexpectedly December 28 at UPMC Presbyterian Hospital in Pittsburgh. “Robust” characterizes Baughman perfectly.
            The Latrobe, Pennsylvania, resident, who often posted pictures of himself at the gym on Facebook, was studying to be a physical trainer and worked not one but two jobs, his mother told CNN affiliate WPXI.
            “It doesn’t seem real,” said his mother, Beverly. She recounted that her son looked run-down when she saw him December 23. On December 26, Baughman went to work but left early because he wasn’t feeling well. The next day, he visited the ER at Westmoreland County Hospital. Health personnel immediately decided to fly him to UPMC, where he died less than 24 hours later.
            The cause of his death, as reported by the Allegheny County Medical Examiner, was influenza, septic shock and multiple organ failure. Unlike the usual flu death resulting from pneumonia complications, Schaffner said, “this is a different phenomenon.”
            The viral flu infection stimulated an immune and inflammatory response in Baughman’s body. “This happens to everyone,” Schaffner noted, but when the person is a “very strong, robust person,” there are times when that response is “overwhelming.” In such cases, cytokines — proteins created as part of the inflammatory response — create a “cytokine storm” in the body. “And this cytokine storm can actually lead to sepsis in the person.”
            Braugham’s parents hope that by sharing his story, they might save someone else.
            “I just think he ignored it and thought it would go away, like most people,” his mother said. Added his father, Todd: “Don’t let things go. Whenever you have fever and you have it multiple days, don’t let it go. Get it taken care of.”

            Different states, different responses

            Alabama Gov. Kay Ivey declared a state public health emergency because of the flu on Thursday.
            Scott Harris, acting state health officer at the Alabama Department of Public Health, said the influenza outbreak includes high activity throughout the state but particularly in metropolitan areas. This “crush” means some hospitals are operating over capacity, leaving some patients sitting in ERs. The public health emergency order helps health care professionals manage resources more efficiently and provides leeway so alternative care can be provided when personnel are unable to offer standard care.
            “If you’re sick, please try to stay home if you can do that and get in touch with your health care provider,” Harris said.
            On the West Coast, Dr. Jasjit Singh, a pediatric infectious disease specialist at Children’s Hospital of Orange County, said 27 influenza-related deaths have occurred in California as of December 30: all among adults under 65 years old.
            “It’s been an earlier flu season than in years past,” Singh said. As of January 6, the hospital has admitted about a quarter of the 303 patients seen with influenza A infections, compared with about 19% of the 89 cases seen last year at this time. Meanwhile, of 78 influenza B cases, about 13% required admission, compared with 22% of 27 cases last year.
            Overall, California reported 7,306 laboratory-confirmed cases for the season as of December 30.
            Texas, which laboratory-confirmed 5,585 cases of the flu as of that date, is seeing activity levels “at the highest level — widespread — for a few weeks,” said Lara M. Anton, a press officer for the Department of State Health Services.
            Because the Lone Star State counts flu deaths from death certificate codes, there’s also a “significant lag” between when a death occurs and when the death is reported, she said. However the majority of deaths this season occurred among people 65 and older.

            See the latest news and share your comments with CNN Health on Facebook and Twitter.

            “There are reports of hospitals throughout the state that have needed to divert non-emergency ambulances for periods of time because of overcrowding in their ER,” Anton said. With most hospitals coming off “divert status” within the same day, the state’s hospital system has been managing the increased number of patients. The department continues to monitor the situation closely and “will step in with support when it is requested,” she said.
            Texas is encouraging “anyone with symptoms to stay home and to see their health care provider, as antiviral medications may shorten the duration of their illness,” Anton said. Amid an outbreak in San Antonio, one school took that advice to heart and closed Friday for a “flu day.”
            Correction: A previous version of this story stated that 27 flu deaths occurred in California among people over, not under, the age of 65.

            Read more: http://www.cnn.com/2018/01/12/health/flu-surveillance-cdc/index.html

            Ibuprofen linked to male infertility, study says

            (CNN)Ibuprofen has a negative impact on the testicles of young men, a study published Monday in the journal Proceedings of the National Academy of Sciences found. When taking ibuprofen in doses commonly used by athletes, a small sample of young men developed a hormonal condition that typically begins, if at all, during middle age. This condition is linked to reduced fertility.

            Advil and Motrin are two brand names for ibuprofen, an over-the-counter pain reliever. CNN has contacted Pfizer and Johnson & Johnson, the makers of both brands, for comment.
            The Consumer Healthcare Products Association, a trade group that represents manufacturers of over-the-counter medications and supplements, “supports and encourages continued research and promotes ongoing consumer education to help ensure safe use of OTC medicines,” said Mike Tringale, a spokesman for the association. “The safety and efficacy of active ingredients in these products has been well documented and supported by decades of scientific study and real-world use.”
              The new study is a continuation of research that began with pregnant women, explained Bernard Jégou, co-author and director of the Institute of Research in Environmental and Occupational Health in France.
              Jégou and a team of French and Danish researchers had been exploring the health effects when a mother-to-be took any one of three mild pain relievers found in medicine chests around the globe: aspirin, acetaminophen (also known as paracetamol and sold under the brand name Tylenol) and ibuprofen.
              Their early experiments, published in several papers, showed that when taken during pregnancy, all three of these mild medicines affected the testicles of male babies.

              Testicles and testosterone

              Testicles not only produce sperm, they secrete testosterone, the primary male sex hormone.
              All three drugs then are “anti-androgenic,” meaning they disrupt male hormones, explained David M. Kristensen, study co-author and a senior scientist in the Department of Neurology at Copenhagen University Hospital.
              The three drugs even increased the likelihood that male babies would be born with congenital malformations, Kristensen noted.
              Tringale noted that pregnant and nursing women should always ask a health professional before using medicines.
              Knowing this, “we wondered what would happen in the adult,” he said. They focused their investigation on ibuprofen, which had the strongest effects.
              A non-steroidal anti-inflammatory drug, ibuprofen is often taken by athletes, including Olympians and professional soccer players for example, before an event to prevent pain, Jégou said. Are there health consequences for the athletes who routinely use this NSAID?
              The research team recruited 31 male volunteers between the ages of 18 and 35. Of these, 14 were given a daily dosage of ibuprofen that many professional and amateur athletes take: 600 milligrams twice a day, explained Jégou. (This 1200-mg-per-day dose is the maximum limit as directed by the labels of generic ibuprofen products.) The remaining 17 volunteers were given a placebo.
              For the men taking ibuprofen, within 14 days, their luteinizing hormones — which are secreted by the pituitary gland and stimulate the testicles to produce testosterone — became coordinated with the level of ibuprofen circulating in their blood. At the same time, the ratio of testosterone to luteinizing hormones decreased, a sign of dysfunctional testicles.
              This hormonal imbalance produced compensated hypogonadism, a condition associated with impaired fertility, depression and increased risk for cardiovascular events, including heart failure and stroke.
              For the small group of young study participants who used ibuprofen for only a short time, “it is sure that these effects are reversible,” Jégou said. However, it’s unknown whether the health effects of long-term ibuprofen use are reversible, he said.
              After this randomized, controlled clinical trial, the research team experimented with “little bits of human testes” provided by organ donors and then conducted test tube experiments on the endocrine cells, called Leydig and Sertoli cells, which produce testosterone, explained Jégou.
              The point was to articulate “in vivo, ex vivo and in vitro” — in the living body, outside the living body and in the test tube — that ibuprofen has a direct effect on the testicles and so testosterone.
              “We wanted to understand what happened after exposure (to ibuprofen) going from the global human physiology over to the specific organ (the testis) down to the endocrine cells producing testosterone,” Kristensen said.
              More than idle curiosity prompted such an extensive investigation.

              Questions around male fertility

              The World Health Organization estimates that one in every four couples of reproductive age in developing countries experiences childlessness despite five years of attempting pregnancy.
              A separate study estimated that more than 45 million couples, or about 15% of all couples worldwide, were infertile in 2010, while another unrelated study suggested that men were solely responsible for up to 30% and contribute up to 50% of cases overall.
              Meanwhile, a recent analysis published in the journal Human Reproduction Update found that sperm counts of men in North America, Europe, Australia and New Zealand are plunging. Researchers recorded a 52% decline in sperm concentration and a 59% decline in total sperm count over a nearly 40-year period ending in 2011.
              Erma Z. Drobnis, an associate professional practice professor of reproductive medicine and fertility at the University of Missouri, Columbia, noted that most drugs are not evaluated for their effects on human male fertility before marketing. Drobnis, who was not involved in the new study, has done extensive research into sperm biology and fertility.
              “There is evidence that some medications are particularly harmful to the male reproductive system, including testosterone, opioids, antidepressants, antipsychotics, immune modulators and even the over-the-counter antacid cimetidine (Tagamet),” she said. “However, prescribing providers rarely mention these adverse effects with patients when prescribing these medications. 
              She believes the new study, though small, is “important” because ibuprofen is among the most commonly used medications.
              Though the new research indicates that ibuprofen disrupts the reproductive hormones in healthy young men, she thinks it’s possible there’s an even greater negative effect in men with low fertility. The other OTC drugs concerning for potential fathers are cimetidine and acetaminophen. She recommends that men who are planning to father a child avoid drugs for several months.
              “Larger clinical trials are warranted,” she said. “This is timely work that should raise awareness of medication effects on men and potentially their offspring.”
              Jégou agrees that more study is needed to answer many questions, including whether ibuprofen’s effects on male hormones are seen at low doses and whether long-term effects are reversible.

              See the latest news and share your comments with CNN Health on Facebook and Twitter.

              “But the alarm has been raised now,” he said. “if this serves to remind people that we are really dealing with medical drugs — not with things which are not dangerous — this would be a good thing.”
              “We need to remember that it is a pharmaceutical compound that helps a lot of people worldwide,” Kristensen said. He noted, though, that of the three mild analgesics examined, ibuprofen had “the broadest endocrine-disturbing properties identified so far in men.”

              Read more: http://www.cnn.com/2018/01/08/health/ibuprofen-male-fertility-study/index.html

              Girl has blunt message for Aetna after her brain surgery request was denied

              (CNN)Cara Pressman sobbed in the big red chair in her living room. The 15-year-old tried to absorb the devastating news relayed by her parents: that their insurance company, Aetna, denied her for a minimally invasive brain surgery that could end the seizures that have haunted her since she was 9 years old.

              “When my parents told me, I went kind of blank and started crying,” she said. “I cried for like an hour.”
              Her friends had been lined up to visit her in the hospital for the surgery three days away, on Monday, October 23. Between tears, she texted them that the whole thing was off.
                It was supposed to be a joyous weekend. Cara’s grandparents had come to town to celebrate their 90th birthdays, a jubilant party with more than 100 family and friends crowding her home. The party did go on — just with a lot more stress.
                Cara had multiple complex partial seizures that weekend. When the seizures strike, her body gets cold and shakes, and she zones out for anywhere from 20 seconds to two minutes, typically still aware of her surroundings. Her seizures can be triggered by stress, by being happy, by exerting herself — almost anything. “It’s like having a nightmare but while you’re awake,” she said.
                In the six weeks since the denial, Cara has had more than two dozen seizures affecting her everyday life. Her message to Aetna is blunt: “Considering they’re denying me getting surgery and stopping this thing that’s wrong with my brain, I would probably just say, ‘Screw you.’ ”

                Aetna: We’re looking out for what’s best for patients

                The Pressman family and, separately, Jennifer Rittereiser, a 44-year-old mom who has struggled with seizures since she was 10, approached CNN in recent weeks after they were both denied, by Aetna, for laser ablation surgery, a minimally invasive procedure in which a thin laser is used to heat and destroy lesions in the brain where the seizures are originating.Aetna is the third-largest health insurance provider in the country, providing medical coverage to 23.1 million people.
                Neurologists consider laser ablation, which is performed through a small hole in the skull, to be safer and more precise than traditional brain surgery, where the top portion of the skull is removed in order for doctors to operate. The procedure is less daunting for the patient and parents who make decisions for their children: No one likes the idea of a skull opened and a chunk of brain removed.
                In denying Cara her surgery, Aetna said it considers laser ablation surgery “experimental and investigational for the treatment of epilepsy because the effectiveness of this approach has not been established.”
                “Clinical studies have not proven that this procedures effective for treatment of the member’s condition,” Aetna wrote in its rejection letter.
                The insurance company did approve her for the more invasive and more expensive open brain surgery, called a temporal lobectomy, even though her medical team never sought approval for the procedure.
                The laser surgery is approved by the Food and Drug Administration and is widely recognized within the epilepsy community as an effective treatment alternative to open brain surgery, especially when the location of seizure activity can be pinpointed to a specific part of the brain.
                Dr. Jamie Van Gompel, a neurosurgeon at the Mayo Clinic, disputes Aetna’s assessment. He is not involved in Cara’s care nor Rittereiser’s treatment, but he said Aetna’s assessment is wrong.
                “I would not call it experimental at all,” said Van Gompel, who is leading a clinical trial on the surgery at Mayo as part of a larger national study. “It’s definitely not an experimental procedure. There’ve been thousands of patients treated with it. It’s FDA-approved. There’s a lot of data out there to suggest it’s effective for epilepsy.”
                Van Gompel said a temporal lobectomy carries a much higher risk of serious complications, including the possibility of death. “It’s a big jump to go to a big invasive procedure,” he said.
                Recovery time after open brain surgery can range from six to 12 weeks. By contrast, a patient who undergoes laser ablation can be back to work or at school in less than two weeks. The pain from laser surgery is much less, and extreme headaches are fewer than with open brain surgery, Van Gompel said.
                While laser ablation has not yet undergone large randomized controlled trials, Van Gompel said existing data shows it’s effective more than 50% of the time. He hopes the current clinical trial will show a success rate of 60% to 70% or better in epilepsy patients. Temporal lobectomies, he said, have a slightly better rate, of more than 70%.
                Pressed by CNN for a better explanation on its denial, Aetna stood by its rejection for Cara and Rittereiser, saying it was in the best interest of the patients. But the language was softened slightly.
                “Clinical effectiveness and our members’ safety are the primary criteria we use in determining whether a treatment or service is medically necessary,” Aetna said. “There is currently a limited amount of evidence-based, clinical studies related to laser ablation surgery. As noted by the Epilepsy Foundation, only studies with a very small number of participants have been used to report the effectiveness of this procedure. We consistently evaluate any new studies or additional evidence when developing our clinical policy bulletins, and will continue to do so for this procedure.”
                Contacted for reaction, the Epilepsy Foundation strongly objected to Aetna’s remarks, saying the insurance company took its information out of context. Laser ablation surgery “has emerged as a new minimally invasive surgical option that is best suited for patients with symptomatic localization-related epilepsy,” said Dr. Jacqueline French, the chief science officer with the Epilepsy Foundation.
                “This technology is much less invasive than the alternative, which involves removing a sizeable piece of brain, at a substantially higher monetary and personal cost,” French said. “This path should be available, if the treating epilepsy physician has recommended it, without delay or barriers.”
                Phil Gattone, the president and CEO of the Epilepsy Foundation, said insurance denials and other barriers to treatment have become a common battle for thousands of Americans with seizure disorders.
                Gattone knows first-hand the pain of what Cara’s parents are going through. His own son began having seizures when he was 4 and underwent brain surgery in the early 1990s. “It was extremely challenging for our family to make a decision to remove part of our child’s skull and brain for a surgery that we hoped would end the devastation of seizures that were stopping his development,” Gattone said. “We took this leap of faith and made the decision, and it worked out the best for him.”
                But he added that he and his wife wished laser ablation surgery had been available back then. The device used for laser ablation surgery was approved by the FDA nine years ago. “I know that my wife and I would’ve found much more comfort if we had had (laser ablation) as an option,” he said.
                Gattone said people with seizures, their caregivers and their doctors should not be “spending critical time in the midst of a health-care crisis, filing paperwork, making appeals or otherwise going through the motions of administrative paperwork” trying to get approval for a life-changing operation.
                “The Epilepsy Foundation can understand no reason why an insurance company would place any barrier to delay a treatment that may save an individual’s life, promote the development of the young child’s brain or bring about seizure control,” Gattone said.

                Mom who crashed with kid in car gets denied

                Jennifer Rittereiser lost consciousness behind the wheel of her silver SUV while driving with her 7-year-old son, Robert, in April. Her SUV rammed into a car in front of her and struck it again before veering into oncoming traffic. Her vehicle careened down an embankment, flipped over and came to rest on its side amid a tangle of brush. She narrowly missed slamming into a guardrail and several trees.
                Mom and son somehow managed to walk free unharmed.
                “People were amazed,” she said. “They had a helicopter on the way, actually. I am extremely fortunate just from that sense.”
                Rittereiser has battled seizures since she was 10 and has been able to function with an array of medications in the three decades since. For much of her life, she could tell when the seizures might come.
                These weren’t like the seizures depicted in Hollywood movies; she wouldn’t fall to the ground and writhe. She would zone out for a spell. She could understand people and could still function but couldn’t speak back — or if she did, her words were garbled.
                As an executive in the health care industry, Rittereiser has fallen asleep during meetings. When she senses a seizure coming, she rushes to the bathroom to hide until they go away. One time, she says she urinated on herself at her desk without realizing it.
                Rittereiser had a crash in 2014 in which she rear-ended a car after she had a seizure. No one was hurt in that crash, but she stopped driving for more than a year. Her medications were tweaked, and her seizures were largely kept in check, until the crash this April.
                She was soon evaluated by an array of doctors and recommended for laser ablation surgery. After 34 years of struggling with seizures, she thought her ordeal might finally come to an end. Surgery was set for June 16.
                But in late May, Aetna denied the surgery. She fought Aetna’s decision through a lengthy appeals process. Aetna refused to budge.
                “It’s just not right,” Rittereiser said.
                She said she recently went to Aetna’s website to look up the company’s values. She felt nauseated. “Everything in their core values is not being shown in the way I’m being treated. They’re talking about promoting wellness and health and ‘being by your side.’ “
                She paused, contemplating the company’s “by your side” catchphrase, saying it’s “the most ridiculous thing, because they are the biggest barrier to my success and my well-being going forward.
                “It drives me crazy.”

                Dad: ‘You get so angry’

                Julie Pressman stood near an elevator at her doctor’s office when word came that Cara’s surgery had been denied. The mom fell to the floor and wept.
                She called Cara’s father, Robert. He was at the airport picking up his 90-year-old parents for their birthday party. Mom and Dad rallied for their daughter and gathered strength to break the news. That’s when Cara sat in the red chair, crying inconsolably.
                “Telling Cara was horrible,” her mom said. “Horrible.”
                “It’s just so frustrating for us to know there’s a solution out there — a way to fix our daughter — and some bureaucratic machine is preventing this from happening,” Robert Pressman said. “You get so angry, but you don’t know who to take it out on, because there’s no particular person that’s doing it. It’s this big bureaucracy that’s preventing this from happening.”
                Julie and Robert said the most beautiful day of their lives came on August 20, 2002, when Cara popped into the world and met her 2-year-old sister, Lindsey, for the first time. “That was the day we became a family,” Julie said. “Our love for those girls is amazing. How we got this lucky is beyond us.”
                But that luck has been tested. When Cara was 9, she’d complained of extreme headaches for much of the day one evening, and then in the middle of the night, she began seizing uncontrollably. The family had two black Labradors that had gone to her room and barked like crazy to alert her parents. Cara had bitten her tongue, and blood was running down her face when they got to the room.
                It was a terrifying scene. She was rushed off in an ambulance and underwent a battery of tests. Mom, Dad and Cara never thought they’d still be battling seizures six years later — let alone an insurance company. She’s had seizures on the soccer field, during softball games, on stage during plays, in the classroom. Almost everywhere.
                How does she envision a life without seizures?
                “I don’t know,” she said. “I’ve never had a life without seizures.”
                “You will. You will,” her dad told her.
                “I just don’t know when,” she responded.
                Mom: “It will happen, kiddo.”
                Her mother calls Cara a feisty, petite powerhouse with big marble eyes and long eyelashes and a funny wit to match. She’s a naturally gifted athlete, singer and dancer, but her parents feel that her seizures have kept her from reaching her full potential.

                See the latest news and share your comments with CNN Health on Facebook and Twitter.

                They long for the day when the seizures are gone. The parents said they have paid $24,000 for insurance with Aetna this year. They’re determined to get Cara laser ablation surgery with or without the insurance company’s help. They will appeal Aetna’s latest rejection — but they’re not optimistic.
                In preparation, they’ve begun exploring raiding their retirement funds to pay the $300,000 out of pocket. “Cara is worth every penny, but man,” her mom said. ” ‘Screw Aetna,’ indeed, to quote my kid.”

                Read more: http://www.cnn.com/2017/12/11/health/aetna-surgery-denied-for-girl/index.html

                A journey through a land of extreme poverty: welcome to America

                The UNs Philip Alston is an expert on deprivation and he wants to know why 41m Americans are living in poverty. The Guardian joined him on a special two-week mission into the dark heart of the worlds richest nation

                Los Angeles, California, 5 December

                You got a choice to make, man. You could go straight on to heaven. Or you could turn right, into that.

                We are in Los Angeles, in the heart of one of Americas wealthiest cities, and General Dogon, dressed in black, is our tour guide. Alongside him strolls another tall man, grey-haired and sprucely decked out in jeans and suit jacket. Professor Philip Alston is an Australian academic with a formal title: UN special rapporteur on extreme poverty and human rights.

                General Dogon, himself a veteran of these Skid Row streets, strides along, stepping over a dead rat without comment and skirting round a body wrapped in a worn orange blanket lying on the sidewalk.

                The two men carry on for block after block after block of tatty tents and improvised tarpaulin shelters. Men and women are gathered outside the structures, squatting or sleeping, some in groups, most alone like extras in a low-budget dystopian movie.

                We come to an intersection, which is when General Dogon stops and presents his guest with the choice. He points straight ahead to the end of the street, where the glistening skyscrapers of downtown LA rise up in a promise of divine riches.

                Heaven.

                Then he turns to the right, revealing the black power tattoo on his neck, and leads our gaze back into Skid Row bang in the center of LAs downtown. That way lies 50 blocks of concentrated human humiliation. A nightmare in plain view, in the city of dreams.

                Alston turns right.

                Philip
                Philip Alston in downtown LA. Photograph: Dan Tuffs for the Guardian

                So begins a two-week journey into the dark side of the American Dream. The spotlight of the UN monitor, an independent arbiter of human rights standards across the globe, has fallen on this occasion on the US, culminating on Friday with the release of his initial report in Washington.

                His fact-finding mission into the richest nation the world has ever known has led him to investigate the tragedy at its core: the 41 million people who officially live in poverty.

                Of those, nine million have zero cash income they do not receive a cent in sustenance.

                Alstons epic journey has taken him from coast to coast, deprivation to deprivation. Starting in LA and San Francisco, sweeping through the Deep South, traveling on to the colonial stain of Puerto Rico then back to the stricken coal country of West Virginia, he has explored the collateral damage of Americas reliance on private enterprise to the exclusion of public help.

                The Guardian had unprecedented access to the UN envoy, following him as he crossed the country, attending all his main stops and witnessing the extreme poverty he is investigating firsthand.

                Think of it as payback time. As the UN special rapporteur himself put it: Washington is very keen for me to point out the poverty and human rights failings in other countries. This time Im in the US.

                David
                David Busch, who is currently homeless on Venice beach, in Los Angeles. Photograph: Dan Tuffs for the Guardian


                The tour comes at a critical moment for America and the world. It began on the day that Republicans in the US Senate voted for sweeping tax cuts that will deliver a bonanza for the super wealthy while in time raising taxes on many lower-income families. The changes will exacerbate wealth inequality that is already the most extreme in any industrialized nation, with three men Bill Gates, Jeff Bezos and Warren Buffet owning as much as half of the entire American people.

                A few days into the UN visit, Republican leaders took a giant leap further. They announced plans to slash key social programs in what amounts to an assault on the already threadbare welfare state.

                Look up! Look at those banks, the cranes, the luxury condos going up, exclaimed General Dogon, who used to be homeless on Skid Row and now works as a local activist with Lacan. Down here, theres nothing. You see the tents back to back, theres no place for folks to go.

                California made a suitable starting point for the UN visit. It epitomizes both the vast wealth generated in the tech boom for the 0.001%, and the resulting surge in housing costs that has sent homelessness soaring. Los Angeles, the city with by far the largest population of street dwellers in the country, is grappling with crisis numbers that increased 25% this past year to 55,000.

                Ressy Finley, 41, was busy sterilizing the white bucket she uses to slop out in her tent in which she has lived on and off for more than a decade. She keeps her living area, a mass of worn mattresses and blankets and a few motley possessions, as clean as she can in a losing battle against rats and cockroaches. She also endures waves of bed bugs, and has large welts on her shoulder to prove it.

                She receives no formal income, and what she makes on recycling bottles and cans is no way enough to afford the average rents of $1,400 a month for a tiny one-bedroom. A friend brings her food every couple of days, the rest of the time she relies on nearby missions.

                She cried twice in the course of our short conversation, once when she recalled how her infant son was taken from her arms by social workers because of her drug habit (he is now 14; she has never seen him again). The second time was when she alluded to the sexual abuse that set her as a child on the path towards drugs and homelessness.

                Given all that, its remarkable how positive Finley remains. What does she think of the American Dream, the idea that everyone can make it if they try hard enough? She replies instantly: I know Im going to make it.

                A 41-year-old woman living on the sidewalk in Skid Row going to make it?

                Sure I will, so long as I keep the faith.

                What does making it mean to her?

                I want to be a writer, a poet, an entrepreneur, a therapist.

                Ressy
                Ressy Finley, who lives in a tent on 6th Street in Downtown LA. Photograph: Dan Tuffs for the Guardian

                Robert Chambers occupies the next patch of sidewalk along from Finleys. Hes created an area around his tent out of wooden pallets, what passes in Skid Row for a cottage garden.

                He has a sign up saying Homeless Writers Coalition, the name of a group he runs to give homeless people dignity against what he calls the animalistic aspects of their lives. Hes referring not least to the lack of public bathrooms that forces people to relieve themselves on the streets.

                LA authorities have promised to provide more access to toilets, a critical issue given the deadly outbreak of Hepatitis A that began in San Diego and is spreading on the west coast claiming 21 lives mainly through lack of sanitation in homeless encampments. At night local parks and amenities are closed specifically to keep homeless people out.

                Skid Row has had the use of nine toilets at night for 1,800 street-faring people. Thats a ratio well below that mandated by the UN in its camps for Syrian refugees.

                Its inhuman actually, and eventually in the end you will acquire animalistic psychology, Chambers said.

                He has been living on the streets for almost a year, having violated his parole terms for drug possession and in turn being turfed out of his low-cost apartment. Theres no help for him now, he said, no question of making it.

                The safety net? It has too many holes in it for me.

                Of all the people who crossed paths with the UN monitor, Chambers was the most dismissive of the American Dream. People dont realize its never getting better, theres no recovery for people like us. Im 67, I have a heart condition, I shouldnt be out here. I might not be too much longer.

                That was a lot of bad karma to absorb on day one, and it rattled even as seasoned a student of hardship as Alston. As UN special rapporteur, hes reported on dire poverty and its impact on human rights in Saudi Arabia and China among other places. But Skid Row?

                I was feeling pretty depressed, he told the Guardian later. The endless drumbeat of horror stories. At a certain point you do wonder what can anyone do about this, let alone me.

                And then he took a flight up to San Francisco, to the Tenderloin district where homeless people congregate, and walked into St Boniface church.

                What he saw there was an analgesic for his soul.

                San Francisco, California, 6 December

                The
                The Gubbio project at St Boniface in San Francisco. The church opens its doors every weekday at 6am to allow homeless people to rest until 3pm. Photograph: David Levene for the Guardian


                About 70 homeless people were quietly sleeping in pews at the back of the church, as they are allowed to do every weekday morning, with worshippers praying harmoniously in front of them. The church welcomes them in as part of the Catholic concept of extending the helping hand.

                I found the church surprisingly uplifting, Alston said. It was such a simple scene and such an obvious idea. It struck me Christianity, what the hell is it about if its not this?

                It was a rare drop of altruism on the west coast, competing against a sea of hostility. More than 500 anti-homeless laws have been passed in Californian cities in recent years. At a federal level, Ben Carson, the neurosurgeon who Donald Trump appointed US housing secretary, is decimating government spending on affordable housing.

                Perhaps the most telling detail: apart from St Boniface and its sister church, no other place of worship in San Francisco welcomes homeless people. In fact, many have begun, even at this season of goodwill, to lock their doors to all comers simply so as to exclude homeless people.

                As Tiny Gray-Garcia, herself on the streets, described it to Alston, there is a prevailing attitude that she and her peers have to contend with every day. She called it the violence of looking away.

                Coy
                Coy Catley, 63, in her homeless box made of cardboard sheets on a sidewalk of Tenderloin, San Francisco. Photograph: Ed Pilkington for the Guardian


                That cruel streak the violence of looking away has been a feature of American life since the nations founding. The casting off the yoke of overweening government (the British monarchy) came to be equated in the minds of many Americans with states rights and the individualistic idea of making it on your own a view that is fine for those fortunate enough to do so, less happy if youre born on the wrong side of the tracks.

                Countering that has been the conviction that society must protect its own against the vagaries of hunger or unemployment that informed Franklin Roosevelts New Deal and the Great Society of Lyndon Johnson. But in recent times the prevailing winds have blown strongly in the youre on your own, buddy direction. Ronald Reagan set the trend with his 1980s tax cuts, followed by Bill Clinton, whose 1996 decision to scrap welfare payments for low-income families is still punishing millions of Americans.

                The cumulative attack has left struggling families, including the 15 million children who are officially in poverty, with dramatically less support than in any other industrialized economy. Now they face perhaps the greatest threat of all.

                As Alston himself has written in an essay on Trumps populism and the aggressive challenge it poses to human rights: These are extraordinarily dangerous times. Almost anything seems possible.

                Lowndes County, Alabama, 9 December

                Aaron
                Aaron Thigpen discusses the poor sewage conditions in Butler County. Improper treatment has put the population at risk of diseases long believed to be extinct in the US. Photograph: Bob Miller for the Guardian


                Trumps undermining of human rights, combined with the Republican threat to pare back welfare programs next year in order to pay for some of the tax cuts for the rich they are rushing through Congress, will hurt African Americans disproportionately.

                Black people are 13% of the US population, but 23% of those officially in poverty and 39% of the homeless.

                The racial element of Americas poverty crisis is seen nowhere more clearly than in the Deep South, where the open wounds of slavery continue to bleed. The UN special rapporteur chose as his next stop the Black Belt, the term that originally referred to the rich dark soil that exists in a band across Alabama but over time came to describe its majority African American population.

                The link between soil type and demographics was not coincidental. Cotton was found to thrive in this fertile land, and that in turn spawned a trade in slaves to pick the crop. Their descendants still live in the Black Belt, still mired in poverty among the worst in the union.

                You can trace the history of Americas shame, from slave times to the present day, in a set of simple graphs. The first shows the cotton-friendly soil of the Black Belt, then the slave population, followed by modern black residence and todays extreme poverty they all occupy the exact same half-moon across Alabama.

                There are numerous ways you could parse the present parlous state of Alabamas black community. Perhaps the starkest is the fact that in the Black Belt so many families still have no access to sanitation. Thousands of people continue to live among open sewers of the sort normally associated with the developing world.

                The crisis was revealed by the Guardian earlier this year to have led to an ongoing endemic of hookworm, an intestinal parasite that is transmitted through human waste. It is found in Africa and South Asia, but had been assumed eradicated in the US years ago.

                Yet here the worm still is, sucking the blood of poor people, in the home state of Trumps US attorney general Jeff Sessions.

                A disease of the developing world thriving in the worlds richest country.

                The open sewerage problem is especially acute in Lowndes County, a majority black community that was an epicenter of the civil rights movement having been the setting of Martin Luther Kings Selma to Montgomery voting rights march in 1965.

                Philp
                Philp Alston talks to a resident. Many families in Butler and Lowndes counties choose to live with open sewer systems made from PVC pipe. Photograph: Bob Miller for the Guardian

                Despite its proud history, Catherine Flowers estimates that 70% of households in the area either straight pipe their waste directly onto open ground, or have defective septic tanks incapable of dealing with heavy rains.

                When her group, Alabama Center for Rural Enterprise (Acre), pressed local authorities to do something about it, officials invested $6m in extending waste treatment systems to primarily white-owned businesses while bypassing overwhelmingly black households.

                Thats a glaring example of injustice, Flowers said. People who cannot afford their own systems are left to their own devices while businesses who do have the money are given public services.

                Walter, a Lowndes County resident who asked not to give his last name for fear that his water supply would be cut off as a reprisal for speaking out, lives with the daily consequences of such public neglect. You get a good hard rain and it backs up into the house.

                Thats a polite way of saying that sewage gurgles up into his kitchen sink, hand basin and bath, filling the house with a sickly-sweet stench.

                Given these circumstances, what does he think of the ideology that anyone can make it if they try?

                I suppose they could if they had the chance, Walter said. He paused, then added: Folks arent given the chance.

                Had he been born white, would his sewerage problems have been fixed by now?

                After another pause, he said: Not being racist, but yeah, they would.

                Round the back of Walters house the true iniquity of the situation reveals itself. The yard is laced with small channels running from neighboring houses along which dark liquid flows. It congregates in viscous pools directly underneath the mobile home in which Walters son, daughter-in-law and 16-year-old granddaughter live.

                It is the ultimate image of the lot of Alabamas impoverished rural black community. As American citizens they are as fully entitled to life, liberty and the pursuit of happiness. Its just that they are surrounded by pools of excrement.

                This week, the Black Belt bit back. On Tuesday a new line was added to that simple graphic, showing exactly the same half-moon across Alabama except this time it was not black but blue.

                blue belt south

                It depicted the army of African American voters who turned out against the odds to send Doug Jones to the US Senate, the first Democrat from Alabama to do so in a generation. It delivered a bloody nose to his opponent, the alleged child molester Roy Moore, and his puppetmasters Steve Bannon and Donald Trump.

                It was arguably the most important expression of black political muscle in the region since Kings 1965 march. If the previous entries in the graphic could be labeled soil, slavery and poverty, this one should be captioned empowerment.

                Guayama, Puerto Rico, 10 December

                So how does Alston view the role of UN rapporteur and his visit? His full report on the US will be released next May before being presented to the UN human rights council in Geneva.

                Nobody expects much to come of that: the world body has no teeth with which to enforce good behavior on recalcitrant governments. But Alston hopes that his visit will have an impact by shaming the US into reflecting on its values.

                My role is to hold governments to account, he said. If the US administration doesnt want to talk about the right to housing, healthcare or food, then there are still basic human rights standards that have to be met. Its my job to point that out.

                Alstons previous investigations into extreme poverty in places like Mauritania pulled no punches. We can expect the same tough love when it comes to his analysis of Puerto Rico, the next stop on his journey into Americas dark side.

                Three months after Maria, the devastation wrought by the hurricane has been well documented. It tore 70,000 homes to shreds, brought industry to a standstill and caused a total blackout of the island that continues to cause havoc.