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Our Trip to the State Capitol

Earlier in my M1 year, I learned about organized medicine and through the last few months, I have engaged in ways to promote positive change in our communities. A few weeks ago, my classmates and I had the opportunity to meet with state senators and representatives to advocate for issues on vaccinations, Graduate Medical Education, […] Article source here:Dose of Reality

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Everything Is a Subscription Now

I’m a person with a toilet-paper subscription. I bought it through my Amazon Prime subscription: Every few months, an embarrassing box of toilet paper arrives at my apartment, at which point I’m charged around $30, which includes the 5 percent savings the retailer awarded me to secure my toilet-paper business in perpetuity.

The same thing happens when the pet-supply company sends me two bags of dog food every six weeks, or when Adobe lets me use Photoshop for another month. Instead of CDs and DVDs, Netflix and Apple Music grant me access to movies and music on a rolling basis. A cosmetics retailer sends me beauty-product samples every month. I never use them, but still pay $10 each time.

For most of American consumer history, subscriptions were the province of magazines, cable, and other media: You paid an annual fee, and news and entertainment organizations gave you their new work as it became available. But as digital payment technology has improved and people look for ways to navigate stress, stagnant wages, and online shopping’s near-infinite purchase choices, the value proposition of subscriptions have changed. So too have the kinds of products people can subscribe to.

Today, things that can routinely show up to your doorstep include: misshapen vegetables, personalized vitamin cocktails, dog toys, a vast wardrobe of clothing and accessories, and even a sofa. In a consumer market of disposable fast fashion and cheap assemble-at-home furniture, the idea of wasting less while getting to use nicer, higher-quality things for a monthly fee is a compelling sell. But what’s harder to predict is what might be lost when the effort to buy less stuff turns into renting huge swathes of your daily life.

A subscription, at its base, is simply a schedule of recurring fees that gives consumers continual access to a good or service. A car lease is a subscription, but so is your gym membership and the way you use Microsoft Office. Subscription creep dates to at least 2007, when Amazon launched Subscribe & Save, a service that lets shoppers pre-authorize periodic charges for thousands of consumable goods like sandwich bags or face wash (or toilet paper), usually at a slight discount over individual purchases. Then came Birchbox in 2010, which provides women with miniature portions of beauty products on a monthly basis for $15. At its peak, the company was valued at more than $500 million.

Both Amazon’s and Birchbox’s models have been widely copied, and their success underscores subscriptions’ appeal to businesses and consumers alike, according to Uptal Dholakia, a marketing professor at Rice University. “The pain of payment and the friction of how a person is going to pay is totally gone,” he says. Consumers receive things they need or want without having to make any decisions, and that creates more stable and predictable revenue streams for the businesses they patronize.

The pitch for Feather, a two-year-old startup that lets consumers borrow suites of furniture for their apartments, sounds a little dystopian. “We don’t own our apartments. We don’t own our cars. We don't even own movies anymore. So why own your furniture?” the company asks on its website. It isn’t that Feather is wrong; Millennials are less likely to own homes and cars than their parents were at the same age, and streaming services dominate entertainment so thoroughly that Best Buy has largely phased out CDs in its stores. But in the face of all that instability, don’t you at least want your sofa to be yours? Feather says the new normal is “defined by freedom and flexibility.” But generational precarity is hardly an exciting lifestyle.

Jay Reno, Feather’s founder and CEO, is realistic about the frequently less-exciting circumstances of sofa rental; he’s moved almost a dozen times himself. “Most people in our consumer demographic are looking for disposable furniture,” he explains. “Your life is changing constantly, you’re moving apartments, you have a different layout in each apartment and different furniture needs.” The company currently operates in New York and San Francisco, two hyper-expensive cities where young, often affluent people tend to bounce between apartments and roommate configurations. The furniture they need might change pretty quickly, along with the rest of their lives. Although Feather offers terms as short as three months, Reno says that most of its customers rent for a full year—the length of an apartment lease.

Rent-to-own businesses have a notoriously predatory history with America’s working poor, but But Reno claims Feather is trying to apply a less vampiric approach to what can be a practical service for apartment-dwellers in unpredictable stages of their lives. Traditional rent-to-own models have been accused of profiting off of their customers’ desperation, not their desire for flexibility. According to Reno, Feather is targeting educated, middle-class consumers who can probably qualify for in-store financing at West Elm—the same type of people who might have been proudly buying a new dinette set for their young family at Havertys in the 1980s. But back then, those shoppers could expect their dining area to be the same size for the foreseeable future.

If furniture subscriptions might help consumers delay a purchase decision that feels too permanent to handle, Rent The Runway might help shoppers stop making purchases that have gotten too easy. The dizzying variety offered by online shopping and the pressure to look great on social media create an intense incentive for women to continually expand their wardrobes, which can strain both budgets and the physical limits of one’s closet. Rent The Runway opened in 2009 to rent special-occasion dresses, but in 2015, it launched a $159-per-month service that gives subscribers access to a rotating array of everyday clothing. Users can swap out for new pieces when they’re done or keep them for an extra fee.

The same year Rent The Runway’s subscription service launched, the average American consumer purchased 65 pieces of clothing, even though most people use relatively little of their wardrobe. Surveys estimate that only 20 percent of people’s clothing sees the light of day with any regularity. Most individual pieces are only worn a handful of times before being discarded, usually into landfills. At the same time, super-cheap clothing is more omnipresent than ever, which can make it seem like a smart, budget-conscious choice for refreshing a seasonal wardrobe or flexing on Instagram.

In theory, a wardrobe subscription gives people access to the variety that modern life demands, in addition to the kind of high-end clothing that it would be impossible for most people to wear every day. “We used to be a business that was more about the cherry on top of the sundae because it was something super special,” says Anushka Salinas, Rent The Runway’s chief revenue officer. “Now people are using us as a utility.”

But along with the advantages of variety or quality comes a downside. Whether or not a subscription to breakfast smoothies or Reformation dresses or mattresses makes sense depends on individual consumer circumstances, which Dholakia says people are bad at evaluating on their own. “You tend to overestimate how much you will consume,” he explains. When signing up for meal kit delivery, you might tell yourself you’ll cook three times a week, when actually once or twice is more realistic. In the case of durable goods, Dholakia says, the tradeoff is in the long game: “The consumer pays less, but they don’t get to own the asset and benefit from it.”

Spending $150 per month to lease three different sets of bedroom furniture in three different apartments might give you flexibility, but at the end of those three years, you’ve spent $5,400 and still don’t own any bedroom furniture.

Consumers also seem to be bad at estimating how much they spend on subscriptions. One survey found that when asked to guess their monthly spend on subscription services, Americans’ first guess was around one third of their actual output. Because people aren’t continuously asked to opt in, it can be easy for those who don’t have to pay stringent attention to their monthly budgets to lose track of what’s being siphoned off. Dholakia says that businesses profit from this disregard. “You have to go and revisit all your subscriptions as a consumer every month, or at least every quarter at a minimum,” he explains. He also urges consumers to look carefully at what companies require to cancel service. If a particular program’s terms make it onerous to opt out, that’s a red flag that subscribing may be a bad deal in general.

Dholakia is careful to point out that in companies where subscriptions work, it’s generally because they’re providing a service that people actually want or need, not because the revenue model itself is a golden ticket. Birchbox, one of the early darlings of the subscription economy, has had some well-publicized growth and revenue struggles in recent years as people tired of paying to receive a different mini mascara every month. Blue Apron, which has had its subscription meal kits copied by numerous competitors, had more than a million subscribers in early 2017; by 2018, that number had dropped to fewer than 800,000.

Both Feather and Rent The Runway Unlimited think they have identified places in which the things people are supposed to own don’t really line up with the ways they have to live their lives: A lot of people rent their homes for a lot longer now, and the internet speeds up trend cycles and keeps permanent records of every outfit you’ve ever been photographed in. Owning things is great, but the constant pressure to shop and acquire—and especially to do so beyond one’s means as a signal of success—is wasteful of both material resources and money. For some, buying flexibility and novelty without commitment or unnecessary waste might be worth more than an IKEA sofa or a bunch of Zara clothes.

Rental furniture and wardrobing services remain a bandage on a bullet wound; they can’t address the reasons that so many people who might have lived comfortable, middle-class lives a few decades ago now don’t know where they’ll be living next year. Still, if you’re one of the many people who find themselves squeezed by circumstance, at least there’s probably a company out there willing to meet you where you are.

“Every business owner in every industry has thought about or is thinking about if subscription makes sense for their products and services,” says Dholakia. “We’re going to see subscription in pretty much everything.”

Article source here:The Atlantic

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Products You’ll Love That Also Give Back

We all know that there is power in money — particularly in how you use it. And these products? Well, not only do they rock, but they give back, giving your money even more power. Which is something that we think is pretty darn rad. Made for Freedom Yoga Mat Bags Cause: provide job skills, prevention and restoration to people affected by or at risk of human trafficking Cute, comfy, and functional, these Made for Freedom Yoga Mat Bags ($33 each) make it easy to bring your mat to the gym or studio. Handcrafted using 100 percent cotton fabric, these…

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Article source here:Fit Bottomed Girls

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Do Married Millennials Cheat on Each Other?

Millennials have killed malls, cheese, and bar soap. Their thirst for blood unslaked, they’re now coming for good, old-fashioned cheating.

At least, that’s according to an analysis the sociologist Nicholas Wolfinger published in 2017 on the Institute for Family Studies website. When asked the survey question “Have you ever had sex with someone other than your husband or wife while you were married?” Americans older than 55 turned out to be more adulterous than people younger than 55. In fact, people born between 1940 and 1959—i.e., people currently between 79 and 60 years old—were the ones who report the highest rates of extramarital sex.

Americans have been asked the infidelity question in every iteration of the General Social Survey, a broad questionnaire about cultural attitudes, since 1991. Wolfinger’s analysis found that in the early 2000s, 18-to-55 year olds were more likely have extramarital affairs than older people were. But right around 2004, the lines cross, and younger people became more chaste than their parents:

Wolfinger takes this data to mean that Ashley Madison’s days might be numbered. Today, the hot new thing for married couples, apparently, is having sex (albeit rarely) with each other until they die. “Barring any unforeseen developments,” Wolfinger writes, “we should anticipate a future of more monogamous marriage.”

Whether or not Millennials are doing marriage differently, they’re certainly changing other parts of courtship. Unmarried couples are more likely to cohabitate than they were a decade ago, and the once-fringe online dating scene has become as mainstream as dinner and a movie. Some people engage in polyamory, while others have open relationships, and more people are talking about those arrangements openly. Both marriage and divorce have become more rare since the 1980s. Between it all are an array of “fuckboys,” ghosts, and friends with benefits.

All these factors together complicate Wolfinger’s claim that marriages of the future will be monogamous. Other researchers I spoke with say it’s not possible to know yet whether Millennials are actually going to have more faithful marriages than Boomers. Several pointed out to me that it the Institute for Family Studies is a blog attached to a think tank dedicated to marriage and family, not a peer-reviewed academic journal.

Wendy Manning, a sociologist at Bowling Green State University, told me there’s no evidence that young adults who are between the ages of 24 and 32 today are more likely to be faithful than the same age group was in 1980. The difference Wolfinger is picking up on, she says, seems to be just that people over 50 are simply older and possibly have been married longer, so they’ve had more opportunities to cheat. We’d have to wait until Millennials get older before determining whether they are, truly, the faithful generation.

There is some limited data to bolster Wolfinger’s point, however. In 2017, Lindsay Labrecque and Mark A. Whisman at the University of Colorado Boulder found that even though the percentage of Americans who think extramarital sex is “always wrong” significantly declined between 2000 to 2016, there was a small but statistically significant decline in the lifetime prevalence of extramarital sex in the same time period. That could mean that the people who were eligible to participate in the survey in 2016 but not 2000, including Millennials, are more open to cheating philosophically, but still less likely to do it.

It’s hard to draw firm conclusions about generations, but Wolfinger’s analysis might be pointing to changing behavior among the subset of Millennials who do choose to get married. To get a sense of how married Millennials think about commitment, I reached out to married Millennials and Gen Xers through Twitter to ask those who are convinced they would never cheat on their spouse: why? Dozens replied via email and direct message. Twitter, obviously, is not a representative sample of the U.S.; its users tend to be more liberal and educated. However, even among this relatively left-leaning group, many people said they knew of very few cheaters in their social circle, and those who did cheat were looked down upon by their friends.

Junie Gray, a woman from Austin, Texas, told me she doubts she could find someone who “understands, supports, and loves” her like her husband does. Since people today wait longer than previous generations to get married, many simply might be selecting the actual right person for them. There’s no need to cheat when your spouse is your best friend, your soulmate, your “everything.” There’s no “one that got away”; you caught him. It just took you until you were 36 to do so.

As the Johns Hopkins University sociologist Andrew Cherlin put it to me, “over the past few decades, marriage has become more selective.” Today, the people most likely to have lasting marriages are those who have gone to college. And college graduates seem “more committed to each other and to the marriage,” Cherlin says. He points out that the divorce rate has gone down significantly for college-educated couples, but not for couples in which neither person has a college education.

I heard from a lot of people who prudently dated their partners for several years before getting married, then waited still more years before having children, just in case. There’s less societal browbeating these days to move faster. “There isn’t pressure to be in relationships like there used to be, so people are less likely to settle for a bad partner,” says Skylar Dallmeyer-Drennen, an energy consultant in Washington D.C. “Why put up with a cheater if no one needs you to be dating?”

This phenomenon is intertwined with what my colleague Kate Julian described as “the sex recession.” Young people today have less sex in general, so it follows that they are likely having less of it extramaritally, too. “We’re living in an astonishingly sexlessless age,” Wolfinger told me.

Of course, we are also living in the midst of a sexual-harassment crisis. But a number of #metoo offenses seem to be perpetrated by older men, some of whom blame changing mores for their alleged transgressions. Though there are also stories of young men who don’t know where to draw the line between friendship and romance, experts say that in general, younger people tend to be more supportive of gender equality. Cheating, meanwhile, can feel deeply inequitable. Infidelity sometimes gets lumped in with other types of harm against women: Several of the entries on the “shitty media men” list that was circulated a few years ago involved allegations of affairs.

Or maybe it’s something about being Millennial, rather than a married Millennial, that deters two-timing. A few people who responded to my Twitter inquiry suggested that maybe Millennials in general are still young and idealistic. My generation wants jobs with a purpose, and we want relationships that feel purposeful, too. Or, as a Gen X friend of mine speculated, perhaps Millennials are terrified of breaking rules. We’re so preoccupied with getting recommendation letters and maintaining our brands that we would never sully ourselves with something so carnal and impulsive as infidelity. (My friend asked to remain nameless because he didn’t want to seem like he was justifying adultery.)

In line with this moral-Millennial hypothesis, many young, married people told me it feels less honorable to leave your spouse for someone else. That would imply there was “emotional cheating” going on while the relationship was in progress—another taboo. “You need to spend some time mourning the end of what had become a formative part of your identity,” says Kae Lani Palmisano, a writer and editor in Philadelphia.

There’s also the usual explanation behind the “Millennials are killing …” trend stories: It’s that Millennials are broke, and they simply can’t afford to buy whatever it is that’s being killed. In this case, some Millennials are still traumatized by the recession and struggling to launch their careers. They can’t afford to buy a house without a second, steady partner. When so much of your life is in flux and unstable, it’s nice to have one person who will definitely be there for you. Why screw it up?

Beyond lingering economic worries, many Millennials and Gen Xers are scarred by their parents’ divorces. The peak in the divorce rate was in 1979, right as the oldest Millennials were being born and younger Gen Xers were reaching their tender grade-school years. Millennials were much more likely to be the children of divorce than their children will be, if current trends continue. “The specter of divorce looms large,” says Manning from Bowling Green State University. “And it seems like it’s a big reason why a lot of young adults want to live with someone first. They want to divorce-proof their marriage.”

For some young people, fidelity is a way of vowing to do better than your own parents did. A few people told me they had been so rattled by their parents’ divorce that they resolved never to do the same thing to their kids. “My parents divorced when I was 2,” says Cole Novak, a pastor in Texas. “My entire life has been marked by the effects of my parents’ divorce. And I never wanted my kids to grow up the way that I did.” When women send him flirtatious texts, Novak says he responds by adding his wife to the thread.

Even as Millennials murder America’s cultural standbys, they continue to be somewhat inscrutable. For now, it does seem like their marriages, when they do happen, are more faithful than those of their elders, but it’s just too soon to know for sure whether that will continue. In fact, Wolfinger accepts some of the alternate explanations for what’s going on here. “Do people in their fifties and sixties have the most extramarital sex because they’re in midlife and have been married for 20-30 years, or because they came of age at a time that fostered greater sexual exploration?” he writes. “The answer is probably ‘both.’”

In other words, yes, it might simply be the case that people over 55 are getting older, growing disinterested, and applying the looser sexual mores they grew up in to sex lives that have grown a little stale. “Being married for a long time means a couple of things: Your kids might be out of the house, you might be bored having sex with your partner,” Wolfinger told me.

Or as a Boomer might say, it might just be that Millennials will understand when we’re older.

Article source here:The Atlantic

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Hot and Healthy Summer Food Trends

Some summer trends we’re seeing right now leave us lukewarm — like, are we honestly doing this again? But others — especially those in the health food realm — have us more like: via GIPHY Here are a few that have us psyched to see what other goodies summer has in store! Yogurt That Goes Beyond the Cow Well, if this doesn’t moo-ve you, then we don’t know what will. Yogurt is coming in so many different varieties these days! Bellwether Farms Sheep Milk Yogurt is heating up the refrigerated section with 60 percent more protein than normal yogurt and…

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Podcast Ep 111: Nealy Fischer, The Flexible Chef

Nealy Fischer, who you might better know as The Flexible Chef, inspires people all over the globe to live a healthier, well-rounded lifestyle. Armed with a “little black book” of favorite recipes, workout methods, yogis and health professionals, she founded MAYYA, which runs luxury wellness events across Asia. Nealy describes herself as a recovering perfectionist — something many of us can relate to, right? She believes we’d all feel better and happier if we could just ditch our goals of perfection in the kitchen and focus on filling our meals with a little more fun and meaning. She counts fixing…

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Article source here:Fit Bottomed Girls

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7 Budget-Friendly Tips for Your Next Family Vacation

Although I’m pretty homebound from now until the twins make their debut (also the reason why I’ll be Skyping in for this!), now that summer is just around the corner, I’m thinking of all the summer family vacations yet to come. Disney is always up there as a dream, along with any destination that has a beach or mountains (or, let’s be honest, wine!). However, with my family expanding from a party-of-three to a party-of-five, affordability is definitely a key factor for any future family vacay. And, I imagine I’m not alone in that need, huh, mamas? So! Without further…

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Article source here:Fit Bottomed Girls

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Pete Buttigieg’s Foreign-Language Count Is Only Going Up

Peter Buttigieg, the mayor of South Bend, Indiana, and a Democratic presidential candidate, has become famous for speaking lots of languages. Depending on the day and the media outlet, the number rises and falls. He’s been granted six languages, seven languages, and eight languages. After the fire at Paris’s Notre-Dame Cathedral, he dipped into French to answer questions from French media. He fielded questions from Norwegian journalists in Norwegian, which he’s said to have taught himself in order to read novels in the language.

While speaking so many languages may be rare in American public, Buttigieg’s ascent is a textbook polyglot path to fame. An aura tends to grow around multilinguists—and often beyond their control. Their fame can be immediately disqualifying if the stories seem too fantastic to be true. It can also set polyglots up for failure and embarrassment if they rely on their myths for attention and livelihood. Either way, the embellishment of their abilities says more about the era in which they live and the culture that surrounds them than the possibility of speaking a lot of languages in any objective sense.

Hyperpolyglots—the world’s best language-learners—can perform some prodigious linguistic feats. Early in the 20th century, a German diplomat named Emil Krebs, stationed in Beijing, was a favored interlocutor of the Empress Dowager Cixi and could translate 32 languages into and out of German. In 1990, the Scotsman Derick Herning was crowned the most multilingual person in Europe for having 10-minute conversations in 22 languages in a row with native speakers. Hyperpolyglots like these two men must put in tremendous amounts of time and effort. But even in cases of genuine talent, there are recurrent factors that contribute to things getting exaggerated.

One important key to the myth that tends to be built up around polyglots is the vaporous quality of numbers of languages. How many languages can Buttigieg actually speak? His campaign confirmed eight when I reached out: English, Norwegian, Spanish, French, Italian, Maltese, Arabic, and Dari. A specific count of languages, though, can also be an unreliable credential for any polyglot, because a language isn’t a defined unit of measure.

[Read: For a better brain, learn another language]

At a certain point, it’s pegged more to people’s fascination than to actual language abilities. In my 2012 book, Babel No More: The Search for the World’s Most Extraordinary Language Learners, one hyperpolyglot I profiled wouldn’t tell me how many languages he had because he knew he’d lose control. “I would walk in the party and say I spoke nine languages,” he said, “and by the end of the night I would hear that I spoke 24.”

In the media glare, this fraught metric becomes even more unstable. Buttigieg’s linguistic repertoire could continue to swell or diversify, not because he claims more languages but because others do it for him. As soon as Buttigieg popped up on political media, anecdotes poured in about his swooping out of nowhere with his exotic languages. Last month, the writer Anand Giridharadas tweeted that Buttigieg’s Norwegian appeared “like a magic trick.” A South Bend emergency-room doctor sent a message on Twitter to the BuzzFeed writer Ashley C. Ford about the time the mayor materialized in a local hospital and translated in Arabic for a patient. According to the message, Buttigieg had been listening to the police scanner and had heard that an Arabic translator was needed.

The Onion has already joked that Buttigieg “stunned a campaign crowd Wednesday by speaking to manufacturing robots in fluent binary.” (This seems to be an allusion to the most famous movie hyperpolyglot, C-3PO, who is “fluent in over six million forms of communication”—or so he claims.)

No matter the historical period, polyglot mythmaking has thrived on anecdotes of isolated encounters and mini-spectacles. In 1820, a Hungarian named Baron Franz Xaver von Zach visited an Italian cardinal, Giuseppe Mezzofanti, who by that point was a world-famous hyperpolyglot. Von Zach reported that Mezzofanti first addressed him in Hungarian, next in several dialects of German, and then spoke English to an Englishman and Russian and Polish to a visiting Russian prince. Mezzofanti’s reputation as “a monster of languages, the Briareus of parts of speech, a walking polyglott,” as Lord Byron enthused about him, was a litany of such instances.

Modern academic linguists have traded similar stories about Ken Hale, an MIT professor who was said to speak 50 languages. They retell how a clerk at an Irish embassy once begged Hale to switch to English because his Irish was better than hers, and how Hale showed up in an Australian aboriginal village at 10 a.m. to begin fieldwork and was conversing fluently by lunchtime. (Hale died in 2001.)

The polyglot myth can further expand based on how commentators, journalists, and bystanders loosely apply terms like “fluency,” “proficient,” “speaks,” or “knows.” Heavy.com, for instance, claimed that Buttigieg “is proficient in seven languages other than English: Norwegian, French, Spanish, Italian, Maltese, Arabic, and Dari.” But what does “proficiency” mean? Is it the same as “mastery”? (When I asked Buttigieg’s campaign about his languages, I received his list with no verb like “speaks” or “knows”; I asked about his criteria for grouping them but have not heard anything back.) Corporations, universities, and governments have developed fine-grained scales of people’s abilities to read, write, speak, listen, and translate in languages because they need objective measures of those abilities. In the vernacular, those distinctions get flattened.

[Read: The bitter fight over the benefits of bilingualism]

MIT’s Hale tried to counter this by distinguishing between “speaking” a language and “talking in” one, in order to combat the myth he felt forming around him. He could speak only three languages, English, Warlpiri, and Spanish, he would say, but could talk in the rest. His admirers weren’t always convinced. In an interview, he once tried to explain that he doesn’t deserve his reputation as a gifted language learner. It didn’t work. “That is not true,” the interviewer told him.

None of this is meant to cast doubt on or give credence to Buttigieg’s actual language abilities. But the contours of polyglot mythmaking underscore a deep, tenacious belief in language as a form of magic. Somehow, words do things. They reveal, and they hide. Witnessing a conversation in a language you don’t understand confirms words esoteric power. In that light, someone who speaks lots of languages can’t avoid being regarded as a prodigious magician.

Monolinguals aren’t the only ones with this belief. Even in communities where being multilingual is completely ordinary, individuals who know many unusual languages or know them at a very young age are often regarded with awe. So Americans could be forgiven for their fascination with Mayor Pete’s languages, whether his viral moments are embellished sleights of hand or true magic.

Article source here:The Atlantic

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The Hack That Created an Underground Market for Old Medical Devices

One day last June, Doug Boss pulled into a police station parking lot to meet a stranger from Craigslist. His purpose: to buy used insulin pumps. Boss has type 1 diabetes, and he relies on a small pump attached to his body to deliver continuous doses of insulin that keep him alive.

To be clear, he didn’t need to buy used medical equipment on Craigslist. Boss, who is 55 and works in IT in Texas, has health insurance. He even has a new, in-warranty pump sitting at home. But he was thrilled to find on Craigslist a coveted old model made by the medical device company Medtronic and discontinued years ago. What makes these outdated Medtronic pumps so desirable is, ironically, a security flaw. Boss was looking for a pump or two he could hack.

He’s not the only one. In 2014, a few hackers realized that the security flaw in certain Medtronic pumps could be exploited for a DIY revolution. Type 1 diabetes is a disease where the pancreas is unable to produce insulin to control blood sugar. For years, Boss had counted, down to the gram, the carbohydrates in every meal and told his pump how much insulin to dispense. Every cup of coffee (more insulin), every brisk walk (less insulin) turned into a math problem with serious consequences: Extremely high or low blood sugar can both be fatal. The healthy pancreas does these “calculations” to adjust insulin automatically, and for decades researchers have worked toward creating an artificial pancreas that can do the same.

By 2014, the hardware components of a DIY artificial pancreas—a small insulin pump that attaches via thin disposable tubing to the body and a continuous sensor for glucose, or sugar, that slips just under the skin—were available, but it was impossible to connect the two. That’s where the security flaw came in. The hackers realized they could use it to override old Medtronic pumps with their own algorithm that automatically calculates insulin doses based on real-time glucose data. It closed the feedback loop.

They shared this code online as OpenAPS, and “looping,” as it’s called, began to catch on. Instead of micromanaging their blood sugar, people with diabetes could offload that work to an algorithm. In addition to OpenAPS, another system called Loop is now available. Dozens, then hundreds, and now thousands of people are experimenting with DIY artificial pancreas systems—none of which the Food and Drug Administration has officially approved. And they’d have to track down discontinued Medtronic pumps. It can sometimes take months to find one.

Obviously, you can’t just call up Medtronic to order a discontinued pump with a security flaw. “It’s eBay, Craigslist, Facebook. It’s like this underground market for these pumps,” says Aaron Kowalski, CEO of JDRF, a nonprofit that funds type 1 diabetes research. This is not exactly how a market for life-saving medical devices is supposed to work. And yet, this is the only way it can work—for now.

By the time Boss decided to try looping, he had not gotten a good night’s sleep in a decade. Every night, the alarm on his glucose monitor would go off when his blood sugar dipped too low or climbed too high. He’d wake up, do math with a sleep-fogged brain, and either eat a snack or give himself extra insulin. Like many patients with type 1 diabetes, he was sacrificing sleep to stay alive.

OpenAPS changed that. To start looping with OpenAPS, Boss did also need to buy a mini computer called Edison. The Edison receives data wirelessly from his continuous glucose monitor, runs an algorithm to predict future blood sugar, and tells the insulin pump how much to dispense every five minutes to prevent highs and lows. Boss could choose to monitor everything through his phone. But at night, he simply slept. “The sheer idea that I have a chance to sleep through the night… ” he marveled to me. So many other loopers I spoke with echoed the sentiment. Jeremy Pettus, another looper, used to keep apple juice by his bed to guard against perilously low blood sugar. “One day my wife was like, ‘We haven’t bought you apple juice in a long time,’” he says. “That burden of having a dangerous low in the middle of my night completely disappeared.”

The looping algorithm makes these corrections throughout the day, too. Laura Nally, another looper, described to me about how she had always planned out her life hours in advance: Would she be walking a lot at work that day? Eating a meal in a couple hours? Taking a hot shower that can affect insulin absorption? “You’re always thinking, ‘What is the next thing I’m going to be doing?’” she says. With Loop, she still uses an app on her phone to tell the algorithm when she’s eating. (Same with OpenAPS, which is why both systems are technically “hybrid” closed systems rather than fully closed.) But if she is off by a few grams of carbohydrates or walks a little bit more than she expects, Loop can easily make real-time corrections. “Every decision we make we’re trying to hit a bullseye...With Loop, all I’m trying to do is get the dart on the board,” explains Erik Douds, who also uses Loop to manage his type 1 diabetes.

Users of Loop have to carry around an extra device called the RileyLink (in white) that translates the iPhone’s signals to the Medtronic insulin pump and vice versa. To make she didn’t lose it, Laura Nally decided to attach her RileyLink directly to her phone case. (Laura Nally)

Loop and OpenAPS users tend to be a pretty self-selecting bunch, as the systems require buying your own equipment out of pocket and following detailed set-up instructions. It also comes with a bit of a learning curve. But according to one small study and many, many anecdotes, looping is, when done properly, both safe and better than a human brain at managing blood sugar. As the good word about looping spread, demand for the few compatible models of Medtronic pumps has swelled.

Early on, loopers were often able to find old, compatible Medtronic pumps sitting unused in their own closets or a friend’s. Boss had actually gotten his first Medtronic pump from a cousin’s daughter before upgrading to a bigger version he found on Craigslist. Pettus, himself an endocrinologist, got his from a young woman who was his patient. “I have a cute little purple pump,” he says. Douds got his from a friend and looping evangelist who he stayed with while traveling across the country. But when Nally wanted to start looping last year, she was living in the Bay Area, full of tech-savvy early adopters, and everyone she knew with a compatible Medtronic pump was already a looper. She was wary of buying one from a stranger online. Luckily, she ended up winning one of the periodic raffles for a loopable Medtronic pump in an online diabetes group. That’s how coveted the pumps have become.

Read: [My pacemaker is tracking me from inside my body]

An underlying security flaw is still the reason looping is possible with Medtronic pumps. (Would-be loopers are even told to watch out for old pumps whose software have been upgraded to fix the flaw.) The security issue doesn’t bother Boss, whose day job is in IT. There’s a tiny, theoretical risk that someone who knows his pump’s serial number and gets physically close can take over. But, he says, “If I drink coffee in the morning and forget to enter it into my phone, my blood sugar is going to be higher than normal.” The everyday risk of making such a mistake outweighs the remote risk of someone else hacking his pump.

A spokesperson for Medtronic wrote in a statement, “Patient safety is our first priority, and intentional device modifications can adversely impact device performance and put patient safety at risk. Medtronic strongly discourages intentional device modification of our insulin pump systems.”

In the absence of official customer support, loopers have come to rely on each other. Rebecca Vitale told me the only reason she hasn’t quit Facebook is because she uses a group for Loop tech help. (Vitale is also friends with my partner.) From the group, she learned to cover her Medtronic pump in packing tape. The compatible Medtronic pumps, unlike newer models, are not waterproof, and their buttons are especially finicky around moisture. The packing tape keeps it just a bit more sweat and waterproof. It’s a hack around a hack.

Like many loopers, Rebecca Vitale put packing tape on her Medtronic pump to protect it from moisture. (Rebecca Vitale)

The looping community is so tight-knit that the person who wrote the code is sometimes the person answering questions. Hilary Koch, whose son loops, remembers spending two hours on the phone with one of the creators of OpenAPS. She tries to do her part, too. “How you give back is, if you see somebody ask a question you know you can answer, you answer it,” she says. Boss also scours eBay for Edisons, which have since been discontinued, and has given a few to people who want to loop, in return for a small donation to Nightscout, another open-source project used with OpenAPS to remotely access glucose data.

When the creators of OpenAPS, Dana Lewis and Scott Leibrand, shared their code back in 2015, they did so for free. They weren’t in it for money, and that ethos is still very much alive in the looping community today. And so, despite all the people clamoring for loopable Medtronic pumps, attempts to sell one to the highest bidder are met with swift backlash in the online community. The going price is usually around $500. “You’ll see posts for $1,000 to $3,000—and community members are like, ‘Haha no,’” says Lewis. (The sticker price of new Medtronic pumps runs over $7,000.)

Since OpenAPS first became available, looping options have slowly expanded. Another group developed Loop for iPhone, which is more user friendly in some ways but still requires an extra piece of hardware called a RileyLink.

A couple other new options don’t even require Medtronic pumps—but they are currently limited in other ways. AndroidAPS, for example, runs on Accu-Chek or Dana pumps, which are approved in Europe and elsewhere, but not yet in the U.S. The system also goes straight to an Android phone, eliminating the need for an extra device like a RileyLink or Edison. The manufacturer of Dana pumps consulted with the DIY looping community in developing its latest version.

Read: [How do you regulate a self-improving algorithm?]

Erica Potter liked the fact that her eight-year-old daughter would not need to carry around another part with AndroidAPS. But her family lives in the U.S., where no compatible pumps are sold. Through a contact in the diabetes community, Potter managed to find a medical supply company in north Africa that would ship a Dana pump overseas. It came out to $2,000 with supplies and shipping.  The set-up has worked so well that Potter has ordered a second pump for her six-year-old, who was recently diagnosed with type 1 diabetes. “I’m aiming for perfection because these are my kid’s organs,” she says. She is waiting for that second pump to ship right now.

More recently, loopers have started testing a hacked version of another pump called Omnipod, which is available in-warranty and tubeless. (Think about the convenience of AirPods versus regular earbuds, except for something that goes under your skin.) Public testing of the Loop-Omnipod system began just last week. Kate Farnsworth, who runs a Facebook group about looping and whose own daughter loops, saw her group gain 1,000 new members in just a few days, buoyed by interest in Omnipod. “I think we’ll have a lot of new loopers,” she says.

Even with these new options, DIY looping is still on the margins of the official healthcare system: It’s going overseas to buy pumps not yet approved in the U.S. It’s testing an experimental version with Omnipod. And in most cases in the U.S., it’s been finding old, out-of-warranty Medtronic pumps. Loopers with Medtronic pumps told me they worried their decade-old devices might break, and they’d have no way to fix it. Boss has a couple backup pumps stockpiled. Kowalski, of the nonprofit JDRF, told me that he once saw his brother, who is also a looper, watching soldering videos on YouTube when something broke. “People are doing wacky stuff,” he says. “We don’t want wacky. We want them to use things like they normally would.” JDRF, which is a major funder of artificial pancreas research, has been working to make the technology mainstream.  

In fact, the FDA approved a looping system from Medtronic called the Minimed 670G in 2016, after the first people started using OpenAPS. The DIY loopers I spoke to had various reasons for sticking with their DIY setup, though: It gave them more flexibility in setting their target blood sugar. It allowed them to use their preferred glucose monitor rather than Medtronic’s.

A nonprofit called Tidepool is now running a clinical trial to get Loop approved by the FDA.  It’s also partnered with the company behind Omnipod to make the next version of its pods officially Loop-compatible—a more formalized version of the DIY Loop-Omnipod system that hackers just made available for public testing.

JDRF, which is a funder of Tidepool, has put forth a vision of a “plug and play” artificial pancreas. Currently, Medtronic’s MiniMed 670G locks the patient into a Medtronic pump, Medtronic glucose sensor, and Medtronic software. The idea, says Kowalski of JDRF, is to have multiple compatible pumps and glucose sensors and algorithms, so that patients can mix and match what they prefer. Looping, in whatever form, is almost certainly the future for type 1 diabetes. It might be all that kids today ever know.

Koch’s son is almost 13 now, old enough to start learning how to manage diabetes on his own. She reflected on the years of interrupted sleep, of weighing the carbs in every meal he brought to school, of ticking off minutes for his blood sugar to drop before he could eat a snack. He’s been looping for over two years now, and some of those memories are starting to fade. “He will never know it like we did,” she says. “And I think that’s a wonderful thing.”

Article source here:The Atlantic

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This Gym Prides Itself on Being Size Inclusive

We chatted about size inclusivity in gyms and what fitness professionals can do to better support body neutrality and positivity in this recent podcast episode. That chat got so much buzz that we wanted to keep the convo going. Because if there’s one thing we’d like to do in this world, we’d like let everyone know that fit bottoms come in all shapes and sizes. So, when Blink Fitness told us about its body positivity and inclusivity movement at numerous locations across the U.S. and its 2019 campaign,”Every body is different, your gym should be too,” we were like, yep,…

The post This Gym Prides Itself on Being Size Inclusive appeared first on Fit Bottomed Girls.

Article source here:Fit Bottomed Girls

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Measles and the Limits of Facts

Students are currently being quarantined in Los Angeles. Mandatory-vaccination policies have been implemented in Brooklyn. Even President Donald Trump, contrary to prior assertions, today urged people to get children vaccinated.

All for a disease that was declared eliminated in the United States two decades ago.

This week, the Centers for Disease Control and Prevention announced that measles outbreaks have led to the highest number of cases reported in the country since that declaration in 2000.

The overall number of cases—695 so far—is not a significant portion of the millions annually around the world. But it’s the pattern and direction that are striking to global officials, as well as America’s unpreparedness to address the actual source. Among wealthy countries, the United States has, by far, the highest number of children who did not receive the first two measles vaccination doses over the past several years. The American outbreaks are described by officials as multiple and “unrelated,” stretched across 22 states, meaning that each has potential to spread further. But the unifying forces behind them are clear.

[Read: Measles outbreaks are a sign of bigger problems]

As the number of cases has risen in the United States—which has historically been at the fore of global-health campaigns—it has also risen around the world. By 2017, the disease that killed half a million people annually at the turn of the century was down to 110,000. Now, the first three months of the year saw a 300 percent increase from the same period a year ago, according to a report from UNICEF.

The Global Vaccine Alliance ties the issue together, citing a storm of seemingly disparate factors: disinformation campaigns in Europe, a collapsing health system in Venezuela, and pockets of low immunization in Africa. In South Sudan, where hundreds of measles cases have been reported in recent months, efforts to vaccinate people after the country’s civil war appear to have been thwarted because of the difficulty of keeping vaccines cool—not because people are refusing them.

Though the United States’ own outbreaks are unrelated in a physical sense, they are linked to a growing online disinformation movement. In a statement on Thursday, the CDC said the outbreak in New York is significant in part due to “misinformation in the communities about the safety of the measles/mumps/rubella vaccine. Some organizations are deliberately targeting these communities with inaccurate and misleading information about vaccines.”

[Read: How misinfodemics spread disease]

The overall effect is a single, global dilemma. There is no opting out. The death toll will go up or down; the choice is between doing what’s possible to contain the virus and enabling its spread. Media ecosystems have evolved and siloed people in ways familiar to political discourse, but they remain poorly addressed in public health.

In a statement this week, U.S. Secretary of Health and Human Services Alex Azar reiterated a tactic that has proven ineffective at reaching skeptical populations in recent years: telling them what to do. “Vaccines are a safe, highly effective public-health solution that can prevent this disease,” he said. “The measles vaccines are among the most extensively studied medical products we have, and their safety has been firmly established over many years in some of the largest vaccine studies ever undertaken.”

Earlier this month, CNN asked 10 current and former liaison members of the CDC’s Advisory Committee on Immunization Practice about the agency’s plans for countering anti-vaccination disinformation online. The response of the senior director of infection control at the Minnesota Children’s Hospital, Patricia Stanfield, was emblematic: “I feel like on social media, the anti-vaxxers are very sophisticated and active and way ahead of us.” Another official, who declined an interview, issued a statement that included: “It is critical that parents and anyone seeking information about vaccines have access to credible information.”

Research suggests that the reason informed people fall into conspiracy-theory mind-sets often has less to do with a lack of information than with social and emotional alignment. Facts are necessary, but not at all sufficient. Websites and YouTube videos where a federal employee in a suit states various statistics are unlikely to be effective against targeted disinformation campaigns that only need to plant the seed of doubt in the minds of people already skeptical of the medical establishment. The work of global inoculation requires first rebuilding a social contract, which means meeting people on the platforms where they now get their information, in the ways they now consume it.

Article source here:The Atlantic

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AirPods Are the New Cubicles

Once upon a time, offices had walls inside them. They weren’t glass, like the conference rooms of 2019, but made of drywall and usually painted a neutral color, like many of the walls you know and love. Over time, office walls gave way to cubicles. Now, for many office workers, the cubicles are also gone. There are only desks.

If you’re under 40, you might have never experienced the joy of walls at work. In the late 1990s, open offices started to catch on among influential employers—especially those in the booming tech industry. The pitch from designers was twofold: Physically separating employees wasted space (and therefore money), and keeping workers apart was bad for collaboration. Other companies emulated the early adopters. In 2017, a survey estimated that 68 percent of American offices had low or no separation between workers.

Now that open offices are the norm, their limitations have become clear. Research indicates that removing partitions is actually much worse for collaborative work and productivity than closed offices ever were. But something as expensive and logistically complicated as an office design is difficult to walk back, so as Jeff Goldblum wisely intones in Jurassic Park, life finds a way. In offices where there are no walls, millions of workers have embraced a workaround to reclaim a little bit of privacy: wireless headphones.

The arrival of these now-ubiquitous devices has ushered in a new era of office etiquette—and created a whole new set of problems.

Beyond their tethered forebears, Bluetooth wireless headphones are convenient because they allow workers to forget they’re wearing a device and leave their desks without yanking their laptops onto the floor. In open offices, people commonly wander around with their headphones on all day, into bathrooms and kitchens, sometimes listen to nothing at all in order to avoid the constant distraction of compulsory social interaction.

We have Apple to thank for wireless headphones’ proliferation. The tech giant launched its tiny, white AirPods in late 2016 to accompany new iPhones that lacked a traditional headphone jack. Despite initial concern that having two plastic sticks poking out of your ears might look insurmountably lame, AirPods have avoided the demise of other wearable tech like Google Glass by being immediately useful. Industry analysts estimate that tens of millions of pairs of AirPods have been sold already, accounting for as much as 85 percent of the wireless-headphone market. The earbuds even star in ultra-viral videos and TikTok memes as a joke-y symbol of wealth among teens.

For Americans who have already joined the office workforce, AirPods serve a different purpose: tuning out your coworkers without looking excessively hostile. In that capacity, they’ve become indispensable to lots of people, because the hard surfaces, high ceilings, and empty spaces common in open offices help sounds carry. There’s rarely any soft surfaces to dampen them. Jerrick Haddad, a 35-year-old social media strategist in Brooklyn, won’t go to his open office without them. “We moved from offices to an open plan two years ago, and wireless headphones are why I haven’t quit,” he says. “One day I forgot them, and I got up and walked straight to the Apple store to buy a pair of AirPods.”

The same is true for Antigua Samuelson, a 29-year-old Los Angeles resident who works for a medical-marijuana wholesaler. She watches Netflix or Hulu at her desk during slow periods, and without her AirPods, she’d have to find another way to fill significant amounts of idle time. “If I forget to bring them with me, I will go back home and get them,” she says.

According to Ethan Bernstein, a professor at Harvard Business School who studies organizational behavior, it makes sense that this subtle tactic for avoiding constant interaction has seeped into office environments. “People are very good at creating spaces for themselves, and these days you look at everybody, and almost without exception, they’re on their phones with headphones in their ears,” he says. In a 2018 study, Bernstein and his team found that open offices decrease face-to-face interactions among coworkers by as much as 70 percent, in stark contrast to designers’ stated goals of collaborative teamwork.

The proliferation of small, wireless headphones may exacerbate that effect. Since you don’t have to remove AirPods to wander around the office, it can be hard for your coworkers to tell if you’re listening to music or on a conference call, or if you’ve simply forgotten to take them out. For Samuelson, sometimes that’s the point. “Once in a while, I’ll pretend to have them on just so I can eavesdrop on what people are saying,” she admits. And for people who find music as distracting as they find their coworkers, putting on their quiet headphones can be as much of a visual signal as it is an attempt to dampen ambient noise.

It’s not a perfect system. David Grilli, a 33-year-old IT professional, uses his headphones to signal that he wants to be left alone, but the message doesn’t always translate. His coworkers “stand in your field of vision until you take notice and ask what they need, or they start talking immediately as if you're not wearing headphones,” he says. Grilli’s coworkers might just need his attention at inopportune moments, but could also be true that office workers are becoming so used to seeing each other in headphones that they barely register them.

For women, there’s often an extra wrinkle: Wireless earbuds are often so small that they’re entirely invisible under long hair. Bernstein suggests that to send a clearer do-not-disturb signal to colleagues, people might consider larger, over-ear models.

Employers can do some things to help with the confusion, like retrofitting a space with small, private phone booths to give employees somewhere to escape. That solves another headphone problem, too: Even when people can see your AirPods, they still don’t know what you’re doing with them. A person quietly sitting in on a conference call looks pretty similar to a person who’s focused on work while listening to soothing nature sounds or who’s checking Facebook while listening to nothing at all. This ambiguity has prompted a whole new visual language meant to mime the difference to unsuspecting desk-mates. To perform its most common gesture, which indicates that you are on a call, you dramatically motion to your ears while making a face that communicates a sense of semi-smug capitulation: You, too, are currently being inconvenienced by your own importance.

“I do a lot of strategic hair-tucking, gesturing at my ears, and phone-pointing,” says Lisa Derus, a 31-year-old publicist who frequently uses her AirPods for calls both on her long commute between Connecticut and New York City and in her open-plan office. “I learned the hard way that the same ear-tapping motion I'd historically used to signal ‘I'm on the phone’ is the exact same gesture that ends phone calls on my AirPods.”

According to the design psychologist Sally Augustin, all of this irritation has come about because open offices ignore some essential elements of human psychological development. “We get revved up just being around other people, so in a workplace you’ve always got that force energizing you,” she says. “When you’re doing intellectual work, you’ll do it better in an environment that’s generally less energizing.” Although headphones can help filter auditory interruptions, they can’t block visual ones, which Augustin says can be just as disruptive to performance and focus.

AirPods also can’t change the fact that you’re just sitting in the middle of an open room, which Augustin notes is stressful no matter what you’re doing. “When you can be approached from the rear, a little part of your brain is always vigilant,” she says. “It’s not about what you’re looking at on your screen or anything. It’s much more fundamental than that.”

The good news is that trends are already turning away from open offices in favor of designs that have a range of space types, including those that allow workers privacy and relief from constant stimulation. “This is how humans work,” Augustin explains. Evolutionarily, our open-plan stress response goes back to a time long before office politics. “We like to think we’ve come so far from our days on the savanna, but maybe not.”

Article source here:The Atlantic

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Healthy Eating Made Easy With Daily Harvest

Healthy food subscription boxes are hot right now, and I recently had a chance to review one that I found to be extremely cool — Daily Harvest. Daily Harvest is a weekly or monthly plan that delivers frozen, plant-based and farm-fresh smoothies, soups, Harvest Bowls, oat bowls, chia bowls, and lattes to your door. Each item comes in its own cup with the (totally recognizable) ingredients and (super simple) instructions listed on the side. You simply keep them in your freezer until you’re ready to eat, then pull off the top, add the recommended liquid, and either blend, heat, or…

The post Healthy Eating Made Easy With Daily Harvest appeared first on Fit Bottomed Girls.

Article source here:Fit Bottomed Girls

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Targeting Pancreatic Cancer with Radiation & Immunotherapy During the Branches

As a student at the University of Michigan Medical School, your last two years of school are collectively referred to as the Branches. Essentially, it’s a flexible framework of elective time that allows you to pursue your unique interests. Although the prospect of customizing two years of scheduling might sound daunting to some medical students, […] Article source here:Dose of Reality

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The Tragic Consequences of the NHL’s Science Denial

Todd Ewen, a former professional hockey player, took his own life in September 2015 in the basement of his St. Louis home. Ewen had been suffering from depression and memory loss since his retirement from the NHL, in 1998. Before his death, he confided in his wife, Kelli, that he feared he may have chronic traumatic encephalopathy, or CTE—a neurodegenerative disease that most experts agree is linked to repetitive head trauma.

After a grueling decade-plus career in the NHL, Ewen exhibited all the tell-tale symptoms. Kelli sent his brain to the neuropathologist Lili-Naz Hazrati to be analyzed for signs of CTE. Six months later, Hazrati called with shocking results: Ewen did not have CTE. The NHL seized on these results in its defense against a class-action suit brought by former players for the league’s negligence regarding head injuries. Hazrati went on to act as an expert witness for the NHL and pointed to Ewen’s case as an example of the inconsistency in CTE pathology. In her expert report and a subsequent deposition, she claimed that there was no link between CTE and head trauma and that CTE was not a disease at all.

Despite Hazrati’s diagnosis, Kelli was convinced that her husband had had CTE. She had sections of Ewen’s brain sent from the Canadian Concussion Centre to Boston, so a world-leading expert on CTE, Ann McKee, could retest them. In late 2018, McKee announced her own conclusions from the tests: Todd had, in fact, had CTE.

In this short documentary from The Atlantic, Kelli Ewen recounts the role her late husband played in the sport of hockey before and after his death.

Article source here:The Atlantic

[ionecoffman]

The Tragic Post-Hockey Life of an NHL ‘Enforcer’

On January 24, 1987, Todd Ewen, a young right-winger for the St. Louis Blues, knocked the Detroit Red Wings’ notorious tough guy, Bob Probert, unconscious with one bare-knuckled punch to the head. Ewen was a new recruit, just 21 years old, and the punch immediately solidified his place in the Blues’ lineup—as well as his role in the National Hockey League as one of the many players who regularly fought members of the opposing team.

Later that same game, Ewen and Probert fought again, despite Probert having been out cold on the ice less than an hour before. This frequency of violence was typical. Ewen would go on to play 11 seasons, a soldier in the vast army of so-called “enforcers” in that era of the NHL. He would fight almost every game, mashing his fists into a pulp that doctors were forced to reconstruct with wire and screws.

Ewen and Probert’s destinies intertwined after they first met on the ice. Probert was just a year older than Ewen, and he had a similarly grueling decade-plus career. After the two men retired from hockey—in 1998 and 2002, respectively—both started to forget things. They angered quickly. Each would be dead before his 50th birthday.

Their deaths were among the earliest to fan the flames of a national debate about the lasting effects of hockey's brutality on its players' brains. But through a twist, Ewen would become a key figure in the NHL's controversial defense of the sport.

[Read: Does the NHL take concussions seriously?]

During his playing days, Ewen was a gentle renaissance man when he wasn’t on the ice. He wrote children’s books and crafted models out of hockey tape for his young fans. In 1998, Ewen retired from professional hockey and returned to the St. Louis suburbs to live with his wife, Kelli Ewen. After retiring, Kelli noticed changes in Todd. “We just saw some aggression that we hadn't previously seen,” she says. “Mood swings, irritability, and not sleeping. Just a pattern of things that was alarming to me.”

Todd’s behavior only became more erratic. During one episode, he choked Kelli and the police had to intervene. In time, depression and reclusiveness replaced Todd’s anger. He routinely became lost and disoriented in the streets around his own home.

Todd confided in Kelli that he feared he may have Chronic Traumatic Encephalopathy, or CTE—a neurodegenerative disease that most experts agree is linked to repetitive head trauma. Research on the disease has largely focused on former professional football players, but it has also been discovered in former NHL players. In 2010, Probert, the Red Wings’ bruiser, became the second NHL player to be diagnosed with CTE. His death was followed in quick succession by the deaths of four other former players’, all under the age of 40, all diagnosed with CTE.

In 2013, 10 former players launched a class-action suit against the NHL for their negligence regarding head injuries. Todd was aware of the suit but declined to participate. He ended his life in the basement of his home on the afternoon of September 19, 2015.

Damage to the brain caused by hits to the head has been observed for nearly a century. CTE was originally studied in boxers in the 1920s as dementia pugilistica. In the early 2000s, the Nigerian-American neuropathologist Bennet Omalu described the pathology of CTE following research on former pro football players. Since then, CTE has been found in the brains of hundreds of athletes across a wide range of sports. It manifests as small lesions of a protein called tau, which kill the surrounding neurons. The consequences are devastating. Anger, personality changes, and memory loss are common.

After Todd’s death, Kelli and many others were convinced he had CTE. Kelli had Todd’s brain sent to the Canadian Concussion Centre to be analyzed. Six months later, the center’s neuropathologist, Lili-Naz Hazrati, called with shocking results: Todd did not have the disease.

The NHL seized on Hazrati’s negative diagnosis in its defense of the player’s ongoing head-injury class-action suit and in public statements by the league’s commissioner. The NHL’s attorneys argued that Todd Ewen died by suicide because he believed he had CTE, therefore it would be dangerous for the league to warn players about the disease because they might kill themselves in fear. The NHL contracted 19 expert witnesses, including Hazrati, who in their testimonies injected doubt into the science of CTE. (The NHL did not respond to multiple requests for interviews.)

In April 2017, Hazrati invoiced the NHL $25,000 for her work on the trial. In her expert report and in a subsequent deposition on March 2, 2018, she claimed there was no link between CTE and head trauma and that CTE was not a disease at all. In an email response to my repeated requests for an interview, however, a representative provided a statement that appeared to conflict with this claim, saying that “Dr. Hazrati does not deny that concussions can cause damage to the brain, potentially resulting in a progressive neurodegenerative disease.” (Hazrati declined multiple interview requests.)

[Read: How athletic culture still suppresses concussion research]

The science of CTE in inherently contentious. Currently the disease can only be diagnosed posthumously, and since it appears to present itself most commonly in professional athletes, researchers are forced to navigate a complicated web of relationships with athletes, sports leagues, and fellow scientists. The very existence of the disease poses an existential threat to certain sports leagues. While most researchers agree on the basic premise that CTE is a neurodegenerative disease linked to head injury, a cottage industry of CTE deniers has nevertheless sprung up. Hazrati’s research features heavily in the former pro-footballer turned commentator Merril Hodge’s 2018 book, Brainwashed: The Bad Science of CTE and The Plot to Destroy Football.

Image courtesy of Kelli Ewen

In 2014, Arland Bruce III, a retired Canadian Football League player accused The Canadian Concussion Centre, citing Hazrati’s research, of obfuscating the science of CTE in a lawsuit against the CFL and the Concussion Centre’s parent company. The case went to the Supreme Court of Canada, who declined to hear it. Kelli, too, held onto her doubts. She says she repeatedly asked Hazrati to retest Todd’s brain but Hazrati declined. Eventually Kelli had sections of Todd’s brain sent from the Canadian Centre to Boston, where a world-leading expert on CTE, Ann McKee, could retest them. In late 2018, McKee announced her own conclusions from the tests: Todd did in fact have CTE.

By 2018, over 140 former players had joined the class-action suit against the NHL. In July of that year, they were denied class-action status due to conflicts between applicable state laws. The NHL offered a settlement to players in the suit which amounted to roughly $22,000 per player with up to $75,000 in medical treatment. According to a lawyer representing players in the case, most involved are expected to take the settlement.

In November, Hazrati told the Canadian sports network TSN that she does not dispute McKee’s findings, but noted that she was “surprised to see that Todd had so very little [of the] disease for an enforcer.”

Meanwhile, McKee’s positive diagnosis relieved any doubts Kelli had about her husband’s condition. But the results were only partial vindication. The NHL so far has not acknowledged any link between head injuries sustained during the game and CTE. Hockey players still slam into each other day after day. The NHL has taken incremental steps to limit fighting and hits to the head, but as CTE is being found in growing number of hockey players, there’s arguably far more the league could do to save future players from Todd’s path.

Article source here:The Atlantic

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Trump’s Policies Are Scaring Immigrants Away From Essential Health Programs

Lourdes Juarez has lived in North Carolina since 2000, working part-time to help children with disabilities improve their motor skills. Originally from Mexico, she is now a lawful permanent resident of the U.S. with plans to apply for citizenship.

After bouts of pancreatic and liver cancer left her struggling with medical debt, she learned she qualified for Medicaid, the government health program for low-income people. But she had a nagging concern that accepting government benefits would affect her chances of gaining citizenship. She had heard rumors to that effect among her friends and in the news.

Juarez’s fear reflects the growing sense among immigrants that they should avoid public programs, which also include food stamps and certain housing programs, in case it counts against their ability to stay in the country permanently. This past December, Juarez called the Charlotte Center for Legal Advocacy, which reassured her that her citizenship would not be affected if she enrolled in Medicaid. Only then did Jaurez relax and sign up. “I’m now more at ease, but there are other people who are confused and need true information,” she told me through an interpreter.

Last October, the Trump administration released a proposed rule that, if finalized, would affect a part of immigration policy known as “public charge.” Since the founding of the country, several American states had long expelled immigrants who were deemed too poor or otherwise “undesirable.” The U.S. government formally codified the practice in the form of the Immigration Act of 1882. The term public charge has, in past decades, been applied loosely, as PRI reported. In 1911, for example, a 15-year-old Italian immigrant was turned back at Ellis Island because his genitals were too small: “Persons so affected are liable, owing to inability to satisfactorily perform sexual congress, to become addicted to unnatural practices,” a public-health officer wrote at the time.

More recently, the provision has applied to foreigners who hoped to immigrate and non-citizens already in the U.S. who are likely to need long-term institutional care or government cash assistance. The government might consider those factors when it comes time to decide who should be allowed to obtain visas or green cards. With the Trump administration’s new proposed rule, though, the U.S. government would broaden the definition of a public charge, examining whether immigrants have used public-health programs such as food stamps or Medicaid during their time in the U.S. Immigration officials could then look less favorably on legal immigrants who used those benefits when they sought to obtain green cards or extend their immigration status.

Though the number of immigrants this new public-charge determination applies to is much smaller, the consulting firm Manatt estimates that as many as 41.1 million non-citizens and their families, or 12.7 percent of the U.S. population, could be deterred from using public benefits because of a chilling effect resulting from this proposed change.

The proposal was just one in a slew of policies backing up the president’s assertion that America is “full” and should admit fewer immigrants. This month, the Trump administration announced it wants to close a loophole and evict undocumented immigrants from public housing.

In addition to the proposed public-charge rule change, in January 2018, the State Department gave embassies and consulates wider leeway to consider the likelihood that a visa applicant would become a public charge when determining whom to let into the country. Consular officers are now allowed to take into account the past or current use of government programs by the visa applicant’s family when deciding whether to grant the applicant entry. Subsequently, State Department data revealed that visa denials on public-charge grounds rose three-fold between 2017 and 2018.

“What the State Department data show is that anyone sponsoring an immigrant is having a tougher time already,” says Stuart Anderson, a former Immigration and Naturalization Service official under George W. Bush who is now executive director of the National Foundation for American Policy, an organization that analyzed the visa data.

Immigrants became nervous about using public benefits almost immediately after Trump’s election, perhaps due to the president’s inflammatory rhetoric about foreigners. But emerging data from around the country suggests these and other recent proposals have heightened this fear. Though some of the rules haven’t been implemented yet, the mere discussion of these changes has been enough to scare many immigrant families away from health services to which they or their children are legally eligible. “They’re hearing all about all sorts of changes,” says Sonya Schwartz, a senior policy attorney from the National Immigration Law Center. “It all fits together, like, ‘I have to keep a low profile, my life is very risky.’”

Social-services providers, doctors, and attorneys describe immigrant communities that are rife with misinformation and fear. Their immigrant patients and clients steer clear of even those government programs that won’t count against them, in some cases hurting their health as a result.

“I don’t think I’m exaggerating by saying this affects nearly every single immigrant family that I see,” says Lanre Falusi, a pediatrician at Children's National Health System in Washington, D.C. “I’ll see a mom with a newborn, and sometimes … the mom is having trouble affording formula. I talk about programs that they might be eligible for. More and more, I’m having new parents decline, saying ‘I’m not gonna sign up.’”

According to the National Immigration Law Center, which summarized the impacts of the public-charge proposal in a recent fact sheet, health-care providers and insurers in some states have noticed sizable decreases in enrollment in food stamps and Medicaid. After a decade of increases, participation in the food-stamp program among immigrants fell by 8 percentage points from 2017 to the first half of 2018, even though the employment rates among this group remained the same. Politico cited the National WIC Association, the advocacy arm of the government program that provides food to low-income children and mothers, in saying that “nearly two-thirds of WIC providers, from 18 different states, reported they have noticed a difference in immigrant WIC access in the wake of the news about potential changes in the public-charge rules.”

“When the office reaches out to [immigrants] to inform them that proposed changes to the public charge policy have not taken effect, they respond that it is too risky and their attorneys are advising them against receiving benefits,” says Kurt Larrick, the assistant director of the Arlington County Department of Human Services in Virginia, via email. About 200 families stopped receiving WIC benefits in the county between 2017 and 2018.

WIC is not included in the public-charge proposal, but advocates told me this drop is an indication that immigrant families are afraid to use any benefits at all, out of an overabundance of caution. Rodrigo Aguirre, a case manager with Catholic Charities, has seen the same effect with free and reduced-price school lunches, which are similarly not part of the current proposal.

Many immigrants live in mixed-status families, and some reportedly avoid enrolling even the authorized family members in programs, fearing doing so might alert authorities to the presence of an unauthorized parent or spouse. “We have seen clients afraid to have their U.S.-citizen children continue to receive Medicaid, even though for most people that should be fine,” says Laurie Ball Cooper, the legal director of Ayuda, an immigrant-aid organization in the Washington, D.C. area.

When the Kaiser Family Foundation conducted a focus group with 20 immigrant families in 2018, it found that though some of the families were struggling to afford food, they felt signing up for nutrition programs might put them or their family members at risk of deportation. What’s more, a 2019 poll by KFF and the California Health Care Foundation found that 40 percent of uninsured Californians say they are “worried that if they signed up for health insurance, they would draw attention to their own or a family member’s immigration status.”

Advocates told me word of these changes spread through word of mouth or through scraps of information on Spanish- or English-language news. Because the immigration rules are so complex, the message tends to get distilled down: “If you’re an immigrant, and you’re using federal programs, you’re at risk,” says Felusi, the pediatrician, summarizing the sentiment among her patients. Even for those who likely wouldn’t be affected, she says, “it’s difficult for them to rest assured, given that what we know now might change on a whim.”

Occasionally, the game of telephone yields wild theories about immigrant children being forced to serve in the military or being made to pay back their food-stamp benefits later.

Doctors and immigrant-aid attorneys told me they are conflicted about how to counsel immigrant families about using government programs. They emphasize that the rule has only been proposed. Technically, nothing has changed yet. But many nevertheless feel uneasy assuring immigrants that they won’t be affected. Sometimes, advocates said, it comes down to the individual family’s tolerance for risk.

Lisa David, the CEO of Public Health Solutions, the largest WIC provider in New York state, says she sees spikes of people leaving the WIC program any time there’s news about a Trump-administration crackdown on immigrants. “We’ve had families walk in and say, ‘I don’t want these checks anymore, please take me out of your database,’” she says. “I can’t actually tell them ‘don’t worry about it,’ because I can’t say that truthfully.”

The Trump administration, for its part, has denied that the public-charge change is meant to frighten immigrants into not using benefits. An official from the Department of Homeland Security told Politico that the agency is trying to “better align U.S. immigration policy with federal law.” In an email, a State Department official told me, “Public charge determinations are based on a consular officer’s assessment of the totality of the applicant’s circumstances … age; health; family status; assets, resources and financial status; education and skills; and an affidavit of support from a sponsor if one is required by law.” The White House did not return a request for comment.

Robert Rector, a senior research fellow at the conservative Heritage Foundation, argues that the public-charge rule is valuable because it keeps out low-skill immigrants, who, he says, are likely to take in more government services than they pay for. But, he added, “the proper way to implement this rule in the future would be to place it on people before they come into the country rather than after. Trying to apply it to people after they come into the country isn’t going to save very much money.”

Regardless of whether the goal of these measures was to get legal immigrants to stop using government benefits, that appears to be happening. Many are looking to less-tracked means of getting help. Schwartz, from the National Immigration Law Center, says some food banks are seeing an increase in demand. However, many immigrant families work and therefore don’t have time to wait in line at soup kitchens and food pantries.

With this proposal, many immigrants feel they must choose between protecting their chances of staying in the U.S. and protecting their health. Some, advocates say, are choosing America. The families that are declining to participate in WIC are turning to less-healthy food options, David says, like starches and fast food, that will fill up a hungry child on just a few dollars.

Beyond the nutritional deficits, Falusi says she sees families that are ground down by stress, and kids who report vague symptoms of stomach-aches and headaches. She and others paint a picture of an immigrant community that has added hunger to an already long list of worries.

“One time a family came in, and the kid was unmotivated. He had his head down the entire time,” Aguirre says. “The mom said, ‘we don’t have food stamps … so they didn’t have breakfast today.’”

Ena Alvarado-Esteller contributed reporting.

Article source here:The Atlantic